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Minnesota - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Minnesota requires Respite Care Services providers to hold a Chapter 245D Basic Support Service license issued by the Department of Human Services (DHS) before enrolling to serve participants on the BI, CAC, CADI, DD, and Elderly waivers. The service provides short-term relief to unpaid primary caregivers, allowing them to step away while ensuring the waiver participant receives continuous supervision and support in their home or an approved out-of-home setting.

Currently, DHS enforces a temporary 245D licensing moratorium that strictly prohibits new license applications or the addition of new service lines for existing providers. To bypass this freeze, a prospective provider must secure a formal exception request submitted directly by a county or tribal lead agency demonstrating a specific capacity need, making lead agency sponsorship the absolute prerequisite to entering the Minnesota respite market.

1. Service Definition and Scope

In Minnesota, Respite Care Services are defined under the Community-Based Services Manual (CBSM) as short-term care provided to a person due to the absence or need for relief of the primary unpaid caregiver. The service ensures the person's health, safety, and well-being during the caregiver's absence.

Respite can be delivered in the person's home (in-home respite) or in a licensed facility or community setting (out-of-home respite). It is authorized in 15-minute units for short durations or on a daily basis for 24-hour out-of-home care, with specific limitations on consecutive days depending on the waiver program.

2. Regulatory and Oversight Agencies

The Minnesota Department of Human Services (DHS) is the primary regulatory authority for HCBS waiver services, handling both the licensure of providers and the administration of the Medicaid program. Within DHS, the Licensing Division oversees compliance with Chapter 245D standards.

For out-of-home respite provided in institutional or specialized medical settings, the Minnesota Department of Health (MDH) may also hold concurrent jurisdiction over the facility's physical plant and health regulations.

3. Gatekeeping Prerequisites: Who Can Even Apply

Minnesota is currently operating under a strict 245D licensing moratorium for Home and Community-Based Services. DHS has stopped accepting new applications for 245D licenses and stopped adding new service lines to currently licensed providers.

To apply for a 245D license to provide respite, an applicant must first obtain an exception to the moratorium. This exception cannot be requested by the provider; it must be submitted by a county or tribal lead agency that has identified a specific need for the provider's services to ensure people in their jurisdiction can access necessary care.

4. Licensure and Certification Requirements

Unless specifically excluded under CBSM guidelines, respite providers must hold a Chapter 245D Basic Support Service license. This licensure ensures the agency meets Minnesota's baseline standards for health, safety, and person-centered care.

The application process requires the submission of comprehensive policy and procedure manuals, proof of insurance, and a non-refundable application fee. Providers must demonstrate readiness to comply with all 245D requirements, including incident reporting and maltreatment prevention.

5. Medicaid Provider Enrollment

After securing the 245D license, agencies must enroll as Minnesota Health Care Programs (MHCP) providers. Respite is a DHS enrollment-required service, meaning providers cannot bill lead agencies directly without an active MHCP profile.

Enrollment is processed through the Minnesota Provider Screening and Enrollment (MPSE) portal. Providers must link their NPI, upload their active 245D license, and complete all required ownership and disclosure forms.

6. Staffing, Training and Background Checks

All staff providing direct contact respite services must clear a background study through Minnesota's NETStudy 2.0 system before having unsupervised contact with waiver participants. This includes fingerprint-based criminal history checks.

Chapter 245D mandates specific orientation and annual training for all direct support professionals. Training must cover vulnerable adult and child maltreatment reporting, person-centered planning, and the specific needs detailed in the participant's support plan.

7. Documentation, Policies and Records

Providers must maintain rigorous documentation to comply with 245D licensing and MHCP billing standards. This includes maintaining a comprehensive policy and procedure manual that aligns with DHS templates.

Service delivery records must verify the date, time, and duration of respite provided, aligning exactly with the authorized units in the person's support plan. Incident reporting is strictly regulated.

8. Billing, Rates and Claims

Respite services are billed to MHCP using the MN-ITS system. Rates and authorization limits are determined by the lead agency (county or tribe) and documented in the participant's service authorization.

Billing codes depend on whether the service is in-home (typically 15-minute units) or out-of-home (daily rates). Providers can only bill for services after they have been delivered and within the authorized limits.

9. Approval Sequence and Timeline

The approval sequence in Minnesota is strictly linear due to the moratorium. A provider cannot begin the licensure process without first securing a lead agency exception.

Once the exception is granted, the 245D license application takes several months to process. Only after the license is issued can the provider apply for MHCP enrollment via MPSE, which adds additional processing time.

10. Common Denials and Survey Findings

Applications are immediately rejected if submitted without an approved lead agency exception due to the active moratorium. DHS will cancel the application and refund the fee.

During 245D compliance surveys, common citations include failure to maintain current background studies on the NETStudy 2.0 roster and inadequate documentation of required staff training.

11. Key Contacts and Resources

Providers should rely on official DHS manuals and help desks for the most current regulatory guidance. The Community-Based Services Manual (CBSM) is the definitive source for waiver service policy.

For licensing questions, the DHS Licensing Help Desk provides direct support to applicants and current license holders.

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