Adult Foster Care - Provider Corner

Family & Corporate Adult Foster Care without a 245D-HCBS Program License
Family & Corporate Adult Foster Care with a 245D-HCBS Program License
Licensing Laws
Other Helpful Resources
Schedules/Training Dates

Adult Foster Care

Family & Corporate Adult Foster Care without a 245D-HCBS Program License

Adult Foster Care Home Program Plan - This form must be reviewed annually and revised as changes occur in the provision of services.

Adult Foster Care Individual Resident Record

Adult Foster Care New Caregiver Checklist - This document outlines the requirements which need to be met for a new caregiver to provide direct contact services in a licensed AFC home.  AFC providers may use this document or similar documentation to ensure that all AFC Rule and Statute requirements have been completed prior to allowing a new caregiver to provide direct contact services to AFC residents.

Adult Foster Care Placement Process and Checklist for Providers - This document describes the licensing requirements for placement in an Adult Foster Care home.

Appeal/Grievance Procedure - Timelines for appealing negative licensing actions and grievance procedures for providers.

Background Study Instructions for Current License Holders

Background Study Log - The license holder must maintain documentation of background studies initiated for the program.

Competency Rule - This review test must be completed by applicants at initial licensure.  It also may be used as a training aid for AFC homes which employ staff.

Disaster Plan - This form will be used in the case of an emergency involving a pandemic outbreak, natural disaster, or catastrophic event.  Providers must update the licensor within 14 days of any changes to the contact information on the form.

Fire Drill Log - To document provider's fire and storm drills.

Floor and Escape Plan - To diagram provider's home.

Home Safety Checklist - Licensor uses to inspect provider's home.

Incident Report - Provider completes when an accident occurs.

Medical Equipment Training Form - A foster care provider shall not care for an individual who relies on medical equipment to sustain life or monitor a medical condition unless the provider has received the training to operate such equipment as observed and confirmed by a qualified source, and (1) is currently caring for an individual who is using the same equipment in the foster home; or (2) has written documentation that the foster care provider has cared for an individual who relied on such equipment within the past six months; or (3) has successfully completed training with the individual being placed with the provider.  MN Statute 245A.155 provides the definition of "qualified source".

Off-Year Review - This form will be sent to the provider one year after a relicensing visit.  The provider should review the form carefully and document completion of each of the items in order to verify annual compliance with MN Rules and Statutes regarding AFC licensure.

Placement Record - To document resident placements.

Program Abuse Prevention Plan - This plan is completed by the license holder by assessing the residents and physical environment of the licensed facility and surrounding grounds.  The license holder should determine how the risk of harm will be reduced in each area of assessment.  This form must be reviewed annually by the license holder and updated as the needs of the residents change.  This plan should not contain resident names or identifying information.

Relicensing Checklist - Review in preparation for licensing visit.

Staff & Training Log for Corporate Sites - This form must be completed at relicensing time for all corporate Adult Foster Care homes.

Training Log - Caregivers with 0-5 years of licensure/experience are required to complete 12 hours of training annually.  Caregivers with 6+ years of licensure/experience are required to complete 6 hours annually.

Variance Request - An applicant or operator of an AFC home may request a variance from compliance with MN Rule, parts 9555.5105 and 9555.6105 to 9555.6265.  This form must be filled out to request a variance to one of these Rule parts.

Vulnerable Adult Act Training - Annual training on the Vulnerable Adult Act is required by MN Statute 245A.65.  Complete the on-line competency test and follow instructions to obtain a certificate of completion.  All license holders and caregivers must receive a score of 80% or higher to be considered adequately trained on the Vulnerable Adults Act.  Maintain annual certificates with the license holder and caregivers' training logs.

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Family & Corporate Adult Foster Care with a 245D-HCBS Program License

Appeal/Grievance Procedure - Timelines for appealing negative licensing actions and grievance procedures for providers.

Background Study Log - The license holder must maintain documentation of background studies initiated for the program.

Disaster Plan - This form will be used in the case of an emergency involving a pandemic outbreak, natural disaster, or catastrophic event.  Providers must update the licensor within 14 days of any changes to the contact information on the form.

Fire Drill Log - To document provider's fire and storm drills.

Floor and Escape Plan - To diagram provider's home.

Home Safety Checklist - Licensor uses to inspect provider's home.

Placement Record - To document resident placements.

Program Abuse Prevention Plan - This plan is completed by the license holder by assessing the residents and physical environment of the licensed facility and surrounding grounds.  The license holder should determine how the risk of harm will be reduced in each area of assessment.  This form must be reviewed annually by the license holder and updated as the needs of the residents change.  This plan should not contain resident names or identifying information.

Variance Request - An applicant or operator of an AFC home may request a variance from compliance with MN Rule, parts 9555.5105 and 9555.6105 to 9555.6265.  This form must be filled out to request a variance to one of these Rule parts.

Vulnerable Adult Act Training - Annual training on the Vulnerable Adult Act is required by MN Statute 245A.65.  Complete the on-line competency test and follow instructions to obtain a certificate of completion.  All license holders and caregivers must receive a score of 80% or higher to be considered adequately trained on the Vulnerable Adults Act.  Maintain annual certificates with the license holder and caregivers' training logs.

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Licensing Laws

Rule 203 (Adult Foster Care Rule)

9555.5050 – Repealer and effective dates.

9555.5105 – Definitions.

9555.5205 – Applicability.

9555.5305 – Purpose.

9555.5405 – Foster Home Development.

9555.5505 – Local Agency Orientation and Training Role.

9555.5515 – Record on The Residence.

9555.5605 – Assessment.

9555.5705 – Provision of Adult Foster Care Services to Residents of Adult Foster Homes.

9555.6105 – Applicability and Purpose.

9555.6115 – License Application Process.

9555.6125 – Licensing Study.

9555.6145 – Negative Licensing Actions.

9555.6165 – Capacity.

9555.6167 – Individual Resident Placement Agreement.

9555.6175 – Cooperate and Report to Agencies.

9555.6185 – Foster Care Training.

9555.6195 – Prohibitions Against Maltreatment and Discrimination.

9555.6205 – Physical Environment.

9555.6215 – Water and Food.

9555.6225 – Sanitation and Health.

9555.6235 – Adult Foster Home Program.

9555.6245 – Personal Record of Resident in Foster Care.

9555.6255 – Resident's Rights.

9555.6265 – Safeguards for Cash Resources Entrusted to Operator.

Vulnerable Adult Act

Definitions of Maltreatment

Minnesota Department of Public Safety

Minnesota Statute 245A - Human Services Licensing Act

Minnesota Statute 245C - Human Services Background Studies Act

MN Statute 245D - Home and Community-based Services Standards

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Other Helpful Resources

211 Information and Referral - "211" is the national abbreviated dialing code for access to health and human services information and referral.  211 is a free, confidential service with universal social value, accessible to the entire population and national in scope.  211 is for everyone - from individuals, families, and professionals to community agencies, government, and people facing barriers due to language, poverty or personal difficulty.  Calling 211 will help anyone get information and access to vital community services.  The 211 call will be answered 24/7 by an Information and Referral Specialist who assesses the caller's needs and refers the person to the appropriate community, social, health and government services.

Alzheimer's Association - The Alzheimer's Association is the largest national voluntary health organization supporting Alzheimer research and care.

Carbon Monoxide Information

Fire Drill Guidelines

Fire Extinguisher Maintenance

Fire Extinguisher Service

Foster Provider Liability Coverage through Minnesota Joint Underwriting Association - 1-800-552-0013.  All foster care providers in the State of Minnesota licensed by the Department of Human Services, Department of Corrections, approved by a tribal government or a court, and foster clients are automatically covered by the policy.  Adult foster care providers must also live in the home with the clients and be the primary care giver.

MN-ITS Log-In

Office of Inspector General (OIG) Exclusion/Medicare & Medicaid Fraud - A search must be completed monthly by all providers registered as a Minnesota Health Care Provider.  Search for all individuals affiliated with the licensed Adult Foster Care facility.

Office of the Ombudsman for Mental Health and Mental Retardation

Schedule II Controlled Substances - Schedule II controlled substances must be stored in a locked area.

Tax Information - Publication 17 contains tax information regarding certain foster care payments.

The Arc - The Arc is a national organization of and for people with mental retardation and related developmental disabilities and their families.

Services Available to Seniors Booklet

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Schedules/Training Dates

No Meeting Schedules or Training Dates available at this time.

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