How direct care service rates are determined

The methods and regulations for determining service rates vary significantly across more than 100 different types of services that offer direct care in Minnesota. Sometimes a service has an unchanging predetermined rate. But often service rates will vary based on market conditions and a person’s individual support needs.

Review the following information to understand better what a service provider (i.e., an employer) might be receiving for a service rate and what guidelines determine that rate. Note: regulations and service rates can change many times each year. This page is an introduction to direct care service rates and should NOT be used to make decisions about an organization’s practices or budgets.

Related information

Care professional compensation. This webpage includes definitions of some of the terms (e.g., “care professional”) used in the information below.
Requirements for care professional compensation.
The Care professional compensation and service rate comparison spreadsheet (XLS) offers details for more than 100 services in Minnesota that offer some type of direct care support. Please note that rates and regulations can change many times throughout the year. Information in the spreadsheet linked above might require updates or contain errors. Double check state and federal guidelines before making policy or financial decisions. For service-specific questions, email the contact listed in each row. For general questions or suggestions, email PositiveSupports@state.mn.us.

Publishing of service rates

Some service rates are published online; some are not. If the information you need is not posted online, you may make a public information data request at Data requests / Minnesota Department of Human Services. Please note that DHS is not authorized to share some types of information, such as service rate information for a specific person.

Service rates for disability waiver services
Market rates

Some disability waiver services have “market rates” or a variable service rate, meaning the service rate is not the same for every service provider, though sometimes there is a cap to the rate. Market rates allow service providers to request rates that better meet the needs of a person who receives services. The following services are market rate services:
- 24-hour emergency assistance
- Caregiver living expenses
- Chore services
- Crisis respite
- Family training and counseling
- Respite (daily and 15-minute)
- Specialist services
- Transportation (waiver transportation).
To better understand how lead agencies and providers determine these rates, review CBSM - Market rate services (BI, CAC, CADI and DD).

Rate frameworks

Some disability waiver services have framework rates, meaning the rate will vary by employer but the formula for calculating that rate, as determined by Minn. Stat. 256B.4914, is the same across all employers unless they receive a rate exception. Rate frameworks help to calculate service rates uniformly and equitably. The provider proposes a service level to the lead agency. The lead agency uses that recommendation to calculate the service rate. The following services are framework rate services:
Rate frameworks are listed on the Disability waiver rate-setting frameworks webpage. To calculate what a service provider might receive for a service rate and how much is calculated for employee compensation:
1. Scroll down to the chart on the page with the headers Day, Unit based and Residential.
2. Click on the applicable service. The framework will open in Excel.
3. Enter inputs as determined by the person’s needs and approved by the case manager. The numbers that can be changed are highlighted.
Pre-determined rate services

Some disability waiver services have pre-determined rates, meaning the rate does not vary by service provider unless they have a rate exception. The following are pre-determined rate services:
- Homemaker (cleaning, home management and assistance with ADLs)
- Home-delivered meals.
Rate exceptions

When a person who receives support has exceptional needs that cannot be met by the Disability waiver rate system (DWRS), the lead agency (i.e., counties and tribal governments) may coordinate with a service provider to request an exception to the service rate – meaning the service provider may ask for more money. If the service provider asks for additional funds to cover the costs of higher employee compensation, that is how the funds must be used.

While most service providers likely use the funds as requested, care professionals might not always receive those funds from the service provider. If your employer is supporting someone with exceptional needs and you believe they may be receiving a rate exception but not passing along those funds to employees, you may report to the lead agency what you are receiving for staff compensation. If what you report does not match what the service provider reported in their rate exception request, the lead agency may take action to resolve the issue.

Updates on service rates for disability waiver services

Review the Long-term services and supports rates changes webpage to view changes in services rates. Sign up for the Stakeholder eList to receive an email when there are changes.
Service rates for Elderly Waiver (EW), Alternative Care (AC) and Essential Community Supports (ECS) services
State-established rates

With authority under Minn. Stat. 256S, DHS establishes a set rate for most EW, AC and ECS services, meaning they do not change from one service provider or person to the next. These include:
Market rates

Some ECS, AC and EW services have “market rates,” or a variable service rate, meaning the service rate is not the same for every service provider, though sometimes there is a cap to the rate. Market rates allow service providers to request rates that better meet the needs of a person who receives services. The following EW, AC and ECS services are market rate services:
Rates set by the residential services (RS) tool

Some ECS, AC and EW service rates are calculated using the RS tool. The RS tool allows a lead agency (i.e. a county, tribal government or managed care organization) to set foster care service rates up to a person’s case mix budget cap and customized living service rates up to statewide limits by case mix. Learn more:
- Customized living (including 24-hour customized living)
- Adult foster care (corporate and family).
More information on EW, AC and ECS service rates

Review the Rate methodologies for AC, ECS and EW service authorization webpage for more detailed information. Visit Long-term services and supports rates changes webpage to review changes in services rates. Sign up for the Stakeholder eList to receive an email when there are changes.
Service rates for assisted living services
Assisted living service rates are individualized to the person who receives support through the customized living service. Guidelines for customized living service rate information can be viewed at
Service rates for nursing home services

Service rates in nursing facilities vary and are dependent on people's specific needs, where services are being provided, collective bargaining agreements and other factors. Guidelines for these service rates are determined by Minn. Stat. 256R. The Nursing Home Workforce Standards Board provides recommendations to the Minnesota Legislature regarding rates and workforce standards.
Service rates for community first services and supports (CFSS) services
Service rates for consumer directed community supports (CDCS) services
Service rates for Early Intensive Developmental and Behavioral Intervention (EIDBI) services

EIDBI services have set rates outlined in the EIDBI state plan amendment that do not vary by person. The state adjusts service rates based on the level at which the service provider is enrolled. This is based on their level of education, experience and training. Level 1 providers are reimbursed 100% of the rate; level 2 providers are reimbursed 80% of the rate and level 3 providers are reimbursed at 50%. For more information, visit: Overview of EIDBI providers.
Service rates for semi-independent living skills (SILS) services
The rate for SILS services is determined by the lead agency (i.e. the county or tribal government). The state covers 85% of the service rate. The lead agency covers the remaining 15%. SILS is fully administered by lead agencies who individually recruit, negotiate rates and compensate providers in their area using the following guidelines:
- Provider’s capacity, capability and experience.
- Current regional labor market rates for comparable positions in their area/county.
- Availability of the work force, and recruitment and retentions issues.
- Completed risk assessments of the service recipient.
- All other pertinent and idiosyncratic challenges, specifically in greater and rural Minnesota.
For more information, visit Minn. Stat. 252.275.
Service rates for community health workers (CHWs)
Service rates for CHW services are determined by number of clients/group size for health education services and by aggregated units of service per client per month for community health integration services. Minnesota DHS determines the rates, which can be found in the MHCP fee schedule. More information about CHW billing and enrollment can be found at:
Service rates for homeless shelters
Service rates for intermediate care facilities for persons with developmental disabilities (ICF/DD)

Service rates for each ICF/DD facility are determined via a prospective payment system (meaning a fixed, pre-determined payment) based on historical costs, number of beds, license class and legislative updates. These rates may sometimes change if there is a significant change in a person’s condition. For more information, visit ICF/DD manual - rates.
Service rates for hospice
Hospice service rates are determined by both state and federal regulations that take into consideration the region where the service is being provided, the types of staff providing the service and their qualifications, and other factors. For more information, visit:
- Minn. R. 9505.0446
- Code of Federal Regulations Title 42 Chapter IV Subchapter B Part 418 Subpart G - Payment for Hospice Care.
Service rates for state-operated services
Service rates for mental health
DHS determines mental health service rates. Code of Federal Regulations, title 42, chapter IV, subchapter C, part 447, subpart B - Payment Methods: General Provisions requires that Minnesota describe in a state plan the policy and the methods to be used in setting payment rates for each type of Medical Assistance service. State plan amendments can be reviewed on the Minnesota's Medicaid and CHIP state plans website.

More information can be found at:
Service rates for substance use disorder (SUD)
DHS determines SUD service rates. For details about this authority and guidelines, review:
Service rates for veteran services
Veteran service rates are calculated using the Department of Veteran Affairs form 10-5588 (PDF). The daily cost of care is the direct cost plus the indirect cost for the month, divided by the total days of care of all enrollees or residents present in the facility during the month regardless of the payer source. Costs are computed in accordance with:
- Code of Federal Regulations, title 2, subtitle A, chapter II, part 200, subpart E-General Provisions, Federal Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards sections 200.400 - 200.475.
- Code of Federal Regulations, title 38-Veteran’s Benefits, part II, chapter 17, subchapter V, section 1741.
Service rates for birth doula services

Medicaid birth doula service rates are specified under Minn. Stat. 256B.758, which states: “(b) Effective for services provided on or after January 1, 2024, payments for doula services provided by a certified doula are $100 per prenatal or postpartum visit and $1,400 for attending and providing doula services at birth.”
Service rates for Moving Home Minnesota pre-transition non-medical transportation

Contact us

For questions or comments, email PositiveSupports@state.mn.us.