Informational Bulletin 99-8
Housing With Services Establishment Registration
Class A Renewal Of Licenses Expiring Before October 1, 1999
Home Care Licensing Options And Requirements
[NOTE: This Information Bulletin supersedes Information Bulletin 96-3/HWS-1]
I. Purpose of Mailing
- To inform the public that the Assisted Living Home Care Provider (ALHCP) licensure class option is effective August 2, 1999.
- To provide a Housing with Services(HWS) registration form to currently Registered HWS Establishments to re-register.
- To provide an application for renewal for currently licensed Class A home care providers whose license will expire by October 1, 1999.
- To provide information regarding the requirements to register as a Housing with Services Establishment.
- To provide information to determine the need to be licensed as a home care provider.
- To provide information about home care licensure options.
- To clarify that Housing with Services Registration is not a license and does not replace the Board and Lodging license or Corporate Adult Foster Care license, or Home Care license or non-certified Boarding Care Home license.
- To inform the provider community that all previous waivers issued to Class A licensed home care providers in the Housing with Services setting since December 1996 are null and void effective August 2, 1999.
- To inform non-certified boarding care homes of the option to register as a Registered Housing with Services establishment, and then of the option to provide health-related services through a licensed home care agency.
To obtain applications for registering as a Housing With Services provider, licensure as a Class A Provider, and Class Assisted Living Home Care Provider (ALHCP), contact:
Minnesota Department of Health
Health Regulation Division
Licensing and Certification
85 East Seventh Place, Suite 300
St. Paul, Minnesota 55101
Phone: (651) 201-4101
Fax: (651) 201-4110
For all currently Registered Housing with Services Establishments, this mailing is your notice from MDH to re-register as a Housing with Services (HWS) establishment. For all currently licensed Class A home care providers whose license expires before October 1, 1999, this mailing is your notice from MDH, for renewal of your license. Application forms are enclosed and should be returned to MDH as soon as possible with the appropriate fee if you know at this time you wish to continue as a Class A provider. If you are uncertain about which license class you wish to apply for you may delay submitting your renewal until after the training sessions. Your application for a Class A Provider or Assisted Living Home Care Provider should then be submitted by 9/1/99.
II. Registration for Housing With Services
Housing with Services Registration is not a license and does not replace the Board and Lodging license, the Corporate Adult Foster Care license, boarding care home license, nor the home care license.
Those establishments who meet the criteria below must register or continue registration as a Housing with Services Establishment with the Minnesota Department of Health, Facility and Provider Compliance Division.
The criteria are taken from MN Statutes Chapter 144D.01, subdivision 4
Housing with Services (HWS) 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 An establishment is to register as a HWS if during the course of a calendar year, 80% of an establishment's residents are 55 or older, for 6 or more months of that calendar year.
- Offering or providing, for a fee, one or more regularly scheduled health-related services or two or more regularly scheduled supportive services, whether offered or provided directly by the establishment or by another entity arranged for by the establishment.
MN Statutes Chapter 144D.01, subdivision 4 states:
"Supportive Services" means:
- Help with personal laundry,
- Handling or assisting with personal funds of residents, or
- Arranging for medical services, health-related services, social services, or transportation to medical or social services appointments.
- Arranging for services does not include making referrals, assisting a resident in contacting a service provider of the resident's choice, or contacting a service provider in an emergency.
HWS/Home Care Licensure
If your HWS establishment will be offering or providing for a fee, one or more regularly scheduled health-related services, you will need to provide these services through a licensed home care provider. Either you must obtain a home care license, or you may contract with a licensed home care provider to provide any health-related service.
If your HWS will not provide for a fee one or more regularly scheduled health-related services, or offer any health-related services, no home care license is required.
Residents may continue to contract for health-related services, if needed, on their own from a licensed home care provider.
As stated by MN Statutes Chapter 144D.01, subdivision 4,
"Health-related services" include:
Professional nursing services,
Home health aide tasks identified in Minnesota Rules, part 4668.0100, subparts 1 and 2;
4668.0100 Subpart 1 states:
- administration of medications; as provided by subpart 2
- performing routine delegated medical or nursing or assigned therapy procedures, as provided by subpart 4, except items C to H,
- assisting with body positioning or transfers of clients who are not ambulatory;
- feeding of clients who, because of their condition, are at risk of choking;
- assistance with bowel and bladder control, devices, and training programs;
- assistance with therapeutic or passive range of motion exercises;
- providing skin care, including full or partial bathing and foot soaks; and
- during episodes of serious disease or acute illness, providing services performed for a client or to assist a client to maintain the hygiene of the client's body and immediate environment, to satisfy nutritional needs, and to assist with the client's mobility, including movement, change of location, and positioning, and bathing, oral hygiene, dressing, hair care, toileting, bedding changes, basic housekeeping, and meal preparation. Oral hygiene means care of teeth, gums, and oral prosthetic devices.
4668.0100 Subpart 2 states:
- a person who meets the requirements of a qualified home health aide may administer medications, whether oral, suppository, eye drops, ear drops, inhalant, topical, or administered through a gastrostomy tube, if:
- the medications are regularly scheduled;
- in the case of pro re nata medications, the administration of medication is reported to a registered nurse either:
- within 24 hours after its administration;
- within a time period that is specified by a registered nurse prior to administration:
- prior to administration, the person is instructed by a registered nurse in the procedures to administer the medications to each client;
- a registered nurse specifies, in writing, and documents in the clients' records, the procedures to administer the medications; and
- prior to administration, the person demonstrates to a registered nurse the person's ability to competently follow the procedure.
Home care aide tasks as defined in Minnesota Rules, part 4668.0110, subpart 1;
4668.0100, subpart 1 states:
- preparing modified diets, such as diabetic or low sodium diets;
- reminding clients to take regularly scheduled medications or perform exercises;
- household chores in the presence of technically sophisticated medical equipment or episodes of acute illness or infectious disease;
- household chores when the client's care requires the prevention of exposure to infectious disease or containment of infectious disease
- assisting with dressing, oral hygiene, hair care, grooming, and bathing, if the client is ambulatory, and if the client has no serious acute illness or infectious disease. Oral hygiene means care of teeth, gums, and oral prosthetic devices.
Or the central storage of medications.
The following housing settings which do not need to register according to Minnesota Statute 144D.01 subdivision 4:
- A nursing home licensed under chapter 144A;
- A hospital, certified boarding care home, or supervised living facility licensed under sections 144.50 to 144.56; (See explanation of Statute 144.56 subdivision 2b on next page)
- A board and lodging establishment licensed under chapter 157 (food, beverage and
lodging establishments) and Minnesota Rules, parts 9520.0500 to 9520.0670, (program
for mentally ill) 9525.0215 to 9525.0355, 9525.0500 to 9525.0660, or 9530.4100 to
9530.4450, (chemical dependency program) or under chapter 245B:(standards governing
services to mentally retarded);
- Some of these rules have been repealed. Please refer questions to the Minnesota Department of Human Services, (651) 296-6117.
- A board and lodging establishment which serves as a shelter for battered women or other similar purpose;
- A family adult foster care licensed by the Department of Human Services;
("Family adult foster care home" means an adult foster care home that is licensed by the Department of Human Services, that is the primary residence of the license holder, and in which the license holder is the primary care giver.) All other Adult Foster Care (AFC) arrangements are considered Corporate Adult Foster Care and need to register under HWS, if they meet the HWS criteria.
- Private homes in which the residents are related by kinship, law, or affinity with the providers of services;
- Residential settings for persons with mental retardation or related conditions in which the services are licensed under Minnesota Rules, parts 9525.2100 to 9525.2140, or applicable successor rules or laws;
- A home sharing arrangement such as when an elderly or disabled person or single-parent family makes lodging in a private residence available to another person in exchange for services or rent, or both;
- A duly organized condominium, cooperative, common interest community, or owners' association of the foregoing where at least 80 percent of the units that comprise the condominium, cooperative or common interest community are occupied by individuals who are the owners, members or shareholders of the units; or
- Services for persons with developmental disabilities that are provided under a license according to Minnesota Rules, parts 9525.2000 to 9525.2140 in effect until January 1, 1998, or under chapter 245B.
The Minnesota Legislature enacted in 1999, Chapter 144.56, subdivision 2b
The commissioner shall not adopt or enforce any rule that limits a noncertified boarding care home registered under chapter 144D from providing home care services in accordance with the home's registration.
This means that, a non-certified boarding care home registered as a Housing with Services (HWS) Establishment is given the option to obtain a home care license and provide health-related services, and also continue to be licensed as a boarding care home. The home may also contract with a licensed home care agency to provide health-related services.
III. Boarding License, Lodging License and Adult Foster Care License
A lodging establishment means a building, structure, enclosure, or any part thereof used as, maintained as, advertised as, or held out to be a place where sleeping accommodations are furnished to the public as regular roomers, for periods or one week or more, and having five or more beds to let to the public.
A lodging license is issued to a lodging establishment either by the Minnesota Department of Health, Environmental Health Services Division, or in some jurisdictions the licensing authority has been delegated to a county or city.
A boarding establishment means a food and beverage service establishment where food or beverages, or both, are furnished to five or more regular boarders, whether with or without sleeping accommodations, for periods of one week or more.
A boarding license is issued to a lodging establishment either by the Minnesota Department of Health, (MDH) Environmental Health Services Division, or in some jurisdictions the licensing authority has been delegated to a county or city.
Boarding and/or Lodging
If an establishment for five or more residents will be providing sleeping accommodations and meals, a boarding and lodging license is required. If an establishment is not providing meals, meaning residents prepare all meals in their private units, only a lodging license is required.
For further information, please contact Minnesota Department of Health, Environmental Health Services at (651) 201-4570, or your local county government center.
Adult Foster Care
Adult Foster Care licenses are issued through the individual counties and are available for settings of less than five residents. Adult foster care license holder may have a maximum license capacity of five if all persons in care are age 60 or over and do not have a serious and persistent mental illness or a developmental disability.
Adult Foster Care means the provision of food, lodging, protection, supervision, and household services to a functionally impaired adult in a residence and may also include the provision of personal care, household and living skills assistance or training, medication assistance and assistance safeguarding cash resources.
As described earlier, Corporate Adult Foster Care settings, meeting the HWS criteria and providing a health-related service must register as a HWS and obtain a home care license or contract with a licensed home care provider.
For further information, on Adult Foster Care please contact your respective county social services department.
IV. Home Care Licensure Options
Home care providers in the Housing with Services setting will have the option for one or more home care licenses. Providers may choose to operate under one license or have more than one license depending upon their client population and the services they wish to provide.
All previous waivers issued to Class A home care providers since December 1996 for services in the Housing with Services setting, are null and void as of August 2, 1999, the effective date of the Assisted Living Home Care Provider (ALHCP) Licensure Class. These null and void waivers are included in this mailing and are marked, "NULL and VOID"(see attachments 4 and 5). Class A home care providers who were providing services under a waiver, which is null and void as of August 2, 1999, will have the option to continue with their Class A license and/or apply for another licensure class. If a Class A home care provider chooses to keep its Class A license, the Class A provider will be required to be in full compliance with the Class A rules. This includes areas previously waived: training qualifications for home health aides, in-service training, home health aide supervision, service agreements, medication and treatment orders, client records and documentation and the quality assurance plan.
Expanded Service Option for Class A Providers Serving HWS Settings Only
MDH issued effective August 2, 1999, Informational Bulletin 99-7, which provides a mechanism for Class A home care provider to offer central medication storage and registered nurse delegation of insulin administration to unlicenced personnel in HWS settings.
It will not be necessary to submit any waiver/variance requests to MDH for performing these services if the guidelines set forth in informational bulletin 99-7 are followed.
Areas to consider when choosing a home care licensure class:
- What type of population will I be serving?
- What are the basic health related services I want to provide?
- Have I developed written admission and discharge criteria? Does my written services contract required by the HWS law include criteria used by the establishment to determine who may continue to reside in the establishment? (Element #14 of the 17 required elements of the services contract required by the HWS law Chapter 144D.)
- What are the qualifications of my staff who provide personal care, medications and health-related services?
Home care licensure options for HWS include: (See "Overview of Home Care Licensure Classes in the Housing With Services Setting".)
- Class A Professional Home Care provider. This license can offer professional nursing, home health aide services and therapies. Services may be provided in the client's private home and/or a HWS setting.
- Effective August 2, 1999, Class A providers will be able to provide central medication storage in a HWS Establishment and RN delegation of insulin administration to unlicenced personnel by following the guidelines in Informational Bulletin 99-7. This expanded service option applies only to clients of Class A Providers in the Housing with Services setting.
- Class E Assisted Living Provider. The licensee can only offer home care aide tasks, which does not allow for medication administration or delegation of nursing tasks. Services are provided in a residential center. A separate Class E license is required for each setting. Clients served under a Class E license must be ambulatory, (meaning the ability to move about and transfer between locations without the assistance of another person, either with or without the assistance of a walking device or wheelchair), and have no serious acute illness or infectious disease.
- Class Assisted Living Home Care Provider (ALHCP.) This license allows for professional nursing , delegated nursing services, other services provided by unlicenced personnel, or central storage of medications in HWS settings only. The rules for this licensure class establish standards for central medication storage and RN delegation to unlicenced personnel for administration of medications, including insulin injections.
V. What Do I Need To Do To Satisfy HWS and Home Care Licensure Law?
Housing with Services (HWS)
- If you are currently registered as HWS and continue to meet the HWS criteria, complete the enclosed Housing with Services registration and return to MDH. When MDH receives a completed HWS registration form and the $35 registration fee, you will be sent a Housing with Services Registration certification. If you have any questions, please contact: MDH Program Assurance (651) 201-4101.
- If you are a HWS, you must execute a written contract with all residents and the contract must address the 17 points required by MN Statutes 144D.04, Housing with Services Registration law.
- Check with the Minnesota Department of Health's Environmental Health Division regarding the need for boarding and /or lodging licenses at (651)201-4570.
- Contact your respective county social services if serving 1 to 4 residents for Adult Foster Care license. (An adult foster care license holder may have a maximum license capacity of five if all persons in care are age 60 or over and do not have a serious and persistent mental illness or a developmental disability.)
Home Care Licensure
- Obtain a home care license if you plan to provide a health-related service directly in your HWS setting, and currently do not have a home care license. The application form for the Class A and Assisted Living Home Care Provider (ALHCP) are included in this mailing.
- Complete the application form and return with fee.
- If you plan to offer a health-related service by contractual arrangements in your HWS, enter into a written contract with a licensed home care provider.
- If you are currently are a licensed Class A provider and your license expires prior to October 1, 1999, and you wish to continue to be licensed as a Class A provider, please complete the enclosed Class A license application, include the appropriate fee, and return to MDH as soon as possible.
- If you are currently licensed as a Class A and wish to drop this licensure class, notify us in writing using your letterhead stationary. The letter must be dated and indicate the date the license is to be terminated. If you will be replacing the Class A with an assisted living license, please include this letter with your assisted living home care application form. Please include the written notification of dropping the Class A license even if you plan on replacing the Class A license with an ALHCP license. If you are submitting an initial license application to MDH, within 10 days after receiving an application for a license, MDH will acknowledge receipt of the application in writing. The acknowledgment will indicate if the application is complete or whether additional information is required. Once the application is determined to be complete you will receive a background study form. MDH has 90 days to issue a license upon receipt of a complete application and the results of the background studies from the Department of Human Services. Remember, it is possible for a business to hold more than one type of home care license. ALHCP services are provided only in the Housing with Services setting.
If you have questions as to which licensure class is most appropriate for you, refer to the "Overview of Home Care Licensure Classes in the Housing with Services Setting". To obtain a copy of this document, please call the Health Regulation Division , Licensing and Certification Section at (651) 201-4101.
If you have any questions or concerns about the information in this bulletin, please contact the Minnesota Department of Health, Health Regulation Division.
Beginning on November 1, 1999, questions should be directed to:
Licensing and Certification Section: (651) 201-4101