Home and Community Based Services (“HCBS) (“Waiver”) (“245D License”) Provider Enrollment

Complete Home and Community Based Services (“HCBS”) Waiver / 245D license and DHS provider enrollment for basic or intensive services. Does not include filing fees.
Alternative Care and Waiver Service Provider Enrollment with the Minnesota Department of Human Services and all agreements and forms required for compliance with Minnesota and Federal Law.
Pricing – $2950
• Alternative Care (AC)
• Essential Community Supports (ECS)
• Home and community based waivers (BI, CAC, CADI, DD and EW)
Example Services:
24-hour Emergency Assistance
Adult Companion Services
Adult Day Care
Adult Day Care Bath
Assistive Technology
Behavioral Support
• Behavior Professional
• Behavior Analyst
• Behavior Specialist
Caregiver Living Expenses
Case Management
Case Management Aide (Paraprofessional)
Chore Services
Consumer Directed Community Supports (CDCS)
Crisis Respite
Customized Living
Customized Living 24-hour
Day Training and Habilitation (DT&H)
Environmental Accessibility Adaptations
Extended Personal Care Assistance (PCA)
Extended Home Care Services
• Home Health Aide (HHA)
• Home Care Nursing (HCN)
• Therapies (physical, occupational, speech language- pathology, and respiratory)

Family Training and Counseling
Foster Care
Home Delivered Meals
Homemaker Services
Housing Access Coordination
Independent Living Skills (ILS)Training
Independent Living Skills (ILS)Therapies
Night Supervision
Personal Support
Prevocational Services
Residential Care Services
Residential Habilitation
• In-home Family Support Services
• Supported Living Services (SLS)
Respite Care
Specialist Services
Specialized Equipment and Supplies
Structured Day Program
Supported Employment Services
Transitional Services

The 245D “HCBS Waiver” license is issued by DHS under the Medicaid program (“Medical Assistance” in Minnesota). Below is a summary of the programs available for license and the checklist to get a license.

Minnesota residents with disabilities or chronic illnesses who need certain levels of care may qualify for the Minnesota HCBS waiver programs.
These programs are available to persons who choose to reside in the community and meet the eligibility criteria.
Alternative Care (AC) for people over age 65 years who are at risk of nursing home placement (DHS Aging and Adult Services Division administers the AC program)
Brain Injury (BI) Waiver for people with a traumatic, acquired or degenerative brain injury who require the level of care provided in a nursing facility that provides specialized services for persons with BI, or who require the level of care provided in a neurobehavioral hospital
Community Alternative Care (CAC) Waiver for chronically ill and medically fragile people who require the level of care provided in a hospital
Community Alternatives for Disabled Individuals (CADI) Waiver for people with disabilities who require the level of care provided in a nursing facility
Developmental Disability (DD) Waiver for persons with developmental disabilities or a related condition who require the level of care provided in an Intermediate Care Facility for Persons with Persons with Developmental Disabilities (ICF/DD)
Elderly Waiver (EW) for people over the age of 65 years who require the level of care provided in a nursing facility and choose to reside in the community (DHS Aging and Adult Services Division administers the EW program)
If you are providing services that require a 245D license – you must apply for a license.
1) Have all owners and managing officials complete the Waiver Training here: https://mn.gov/dhs/partners-and-providers/training-conferences/minnesota-health-care-programs/provider-training/waiver-ac-provider-training-101.jsp
2) Complete the “245D Pre-Application Worksheet” You will not be submitting this to DHS, but you should fill it out for when you submit your application later as a reference.
3) Create an account at https://elicensing.dhs.mn.gov/ELMS/
4) Complete and submit all additional required materials with your application, including policies and procedures. Providers may use the DHS sample documents for basic or intensive services as a template for their programs by filling in the blanks or modifying them to fit their programs’ format and style.
5)   Have all of the documents ready, and then call 651-431-6624 M-TH, 8am-2:30pm to speak to the waiver worker at DHS to get a link to submit the documents electronically..  It should take about 30 mins to 1 hour to submit the application online.. You just insert all the information from the 245D checklist above. Be prepare to pay a licensing fee electronically.
6) Once approved, Complete the Waiver and Alternative Care (AC) Programs Service Request Form to report the service (s) you plan to provide and determine the qualifications needed to provide the service (s)
7) Verify all employees and anyone related to the company are not on the MHCP Excluded Provider Lists as an excluded group or individual provider. Keep this for your own records. List of Excluded Individuals/Entities (LEIE). Check the Office of Inspector General (OIG)
8) Complete a Home and Community-Based Services (HCBS) Waiver and Alternative Care (AC) Programs Provider Application (DHS-4015)
9) Complete a Minnesota Health Care Programs (MHCP) Provider Agreement (DHS-4138)
10) Complete Assurant statements as appropriate (DHS-6638) (may not apply)
11) Complete a Disclosure of Ownership form (DHS-5259)
12) Submit all copies of owner or managerial official’s Waiver 101 Training transcript showing a result of “mastered” from Step 1
13) Submit a copy of your liability insurance certificate naming “DHS PE” as a certificate holder on the document if providing the
following services:
 Any service that requires you to have a 245D
program license
 Foster Care funded by the EW or AC
programs (unless foster care covered by
 Adult Day Care
 Customized Living
 Residential Care
Send attention MHCP Provider Enrollment
PO Box 64987, St Paul, MN 55164-0987
14) Submit a copy of license, certification or registration if required for the service you are providing if appropriate.
15) Establish your direct deposit or electronic funds transfer (multiple steps, not required initially)
16) MHCP sends you a Welcome Letter to confirm your enrollment. MHCP will assign you a 10-digit Unique Minnesota Provider Identifier (UMPI) in your Welcome Letter. Register for MN-ITS (for submission of electronic claims). MN-ITS initial user ID, password and registration
instructions included in Welcome Letter.
17) Register for Waiver/Alternative Care Billing Lab within 6 months of initial enrollment. This is different from the “Waiver Training” from Step 1. Providers will learn how to navigate the MHCP provider website including: basic provider requirements, programs and services, service specific provider requirements, provider tools and resources, billing for waiver and AC services and payment related audits. Providers will also learn how to use the MN-ITS electronic billing system
18) Maintain compliance with Federal, State and local laws, including HCBS Waiver Services Provider Manual (BI, CAC, CADI and DD waivers) and Elderly Waiver (EW) and Alternative Care (AC) Program Provider Manual. The HCBS Waiver Services Provider Manual includes information about eligible providers, enrollment, MN-ITS, covered/non-covered services, authorization and billing. The Elderly Waiver (EW) and Alternative Care (AC) Program Provider Manual includes information about eligible providers, enrollment, MN-ITS, covered/non-covered services, authorization and billing.

Pricing: $2950 – does not include filing fees

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