Bill Text: MN HF1021 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Long-term care consultation modified, and elderly waiver modified.
Sponsorship: Slight Partisan Bill (Republican 2-1)
Status: (Introduced - Dead) 2011-03-10 - Introduction and first reading, referred to Health and Human Services Finance [HF1021 Detail]
Download: Minnesota-2011-HF1021-Introduced.html
1.2relating to human services; modifying long-term care consultation; modifying
1.3elderly waiver;amending Minnesota Statutes 2010, sections 256B.0911,
1.4subdivision 3a; 256B.0915, subdivisions 3e, 3h, 5, 6, 10.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to
1.7read:
1.8 Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
1.9services planning, or other assistance intended to support community-based living,
1.10including persons who need assessment in order to determine waiver or alternative care
1.11program eligibility, must be visited by a long-term care consultation team within 15
1.12calendar days after the date on which an assessment was requested or recommended. After
1.13January 1, 2011, these requirements also apply to personal care assistance services, private
1.14duty nursing, and home health agency services, on timelines established in subdivision 5.
1.15Face-to-face assessments must be conducted according to paragraphs (b) to (i).
1.16 (b) The county may utilize a team of either the social worker or public health nurse,
1.17or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
1.18assessment in a face-to-face interview. The consultation team members must confer
1.19regarding the most appropriate care for each individual screened or assessed.
1.20 (c) The assessment must be comprehensive and include a person-centered
1.21assessment of the health, psychological, functional, environmental, and social needs of
1.22referred individuals and provide information necessary to develop a support plan that
1.23meets the consumers needs, using an assessment form provided by the commissioner.
2.1 (d) The assessment must be conducted in a face-to-face interview with the person
2.2being assessed and the person's legal representative, as required by legally executed
2.3documents, and other individuals as requested by the person, including the person's
2.4chosen provider of customized living services under section 256B.0915, subdivision 3e,
2.5paragraph (e), who can provide information on the needs, strengths, and preferences of the
2.6person necessary to develop a support plan that ensures the person's health and safety, but
2.7who is not a provider of service or has any financial interest in the provision of services.
2.8 (e) The person, or the person's legal representative, must be provided with written
2.9recommendations for community-based services, including consumer-directed options,
2.10or institutional care that include documentation that the most cost-effective alternatives
2.11available were offered to the individual. For purposes of this requirement, "cost-effective
2.12alternatives" means community services and living arrangements that cost the same as or
2.13less than institutional care.
2.14 (f) If the person chooses to use community-based services, the person or the person's
2.15legal representative must be provided with a written community support plan, regardless
2.16of whether the individual is eligible for Minnesota health care programs. A person may
2.17request assistance in identifying community supports without participating in a complete
2.18assessment. Upon a request for assistance identifying community support, the person must
2.19be transferred or referred to the services available under sections256.975, subdivision 7 ,
2.20and256.01 , subdivision 24, for telephone assistance and follow up.
2.21 (g) The person has the right to make the final decision between institutional
2.22placement and community placement after the recommendations have been provided,
2.23except as provided in subdivision 4a, paragraph (c).
2.24 (h) The team must give the person receiving assessment or support planning, or
2.25the person's legal representative, materials, and forms supplied by the commissioner
2.26containing the following information:
2.27 (1) the need for and purpose of preadmission screening if the person selects nursing
2.28facility placement;
2.29 (2) the role of the long-term care consultation assessment and support planning in
2.30waiver and alternative care program eligibility determination;
2.31 (3) information about Minnesota health care programs;
2.32 (4) the person's freedom to accept or reject the recommendations of the team;
2.33 (5) the person's right to confidentiality under the Minnesota Government Data
2.34Practices Act, chapter 13;
3.1 (6) the long-term care consultant's decision regarding the person's need for
3.2institutional level of care as determined under criteria established in section144.0724,
3.3subdivision 11 , or
256B.092 ; and
3.4 (7) the person's right to appeal the decision regarding the need for nursing facility
3.5level of care or the county's final decisions regarding public programs eligibility according
3.6to section256.045, subdivision 3 .
3.7The person's chosen provider of customized living services under section 256B.0915,
3.8subdivision 3e, paragraph (e), must also be provided with a copy of the long-term care
3.9consultant's assessment as well as the decision regarding the person's need for institutional
3.10level of care as determined under criteria established in section 144.0724, subdivision 11,
3.11or 256B.092.
3.12 (i) Face-to-face assessment completed as part of eligibility determination for
3.13the alternative care, elderly waiver, community alternatives for disabled individuals,
3.14community alternative care, and traumatic brain injury waiver programs under sections
3.15256B.0915
,
256B.0917 , and
256B.49 is valid to establish service eligibility for no more
3.16than 60 calendar days after the date of assessment. The effective eligibility start date
3.17for these programs can never be prior to the date of assessment. If an assessment was
3.18completed more than 60 days before the effective waiver or alternative care program
3.19eligibility start date, assessment and support plan information must be updated in a
3.20face-to-face visit and documented in the department's Medicaid Management Information
3.21System (MMIS). The effective date of program eligibility in this case cannot be prior to
3.22the date the updated assessment is completed.
3.23 Sec. 2. Minnesota Statutes 2010, section 256B.0915, subdivision 3e, is amended to
3.24read:
3.25 Subd. 3e. Customized living service rate. (a) Payment for customized living
3.26services shall be a monthly rate authorized by the lead agency within the parameters
3.27established by the commissioner. The payment agreement must delineate the amount of
3.28each component service included in the recipient's customized living service plan. The
3.29lead agency, in consultation with the provider of customized living services, shall ensure
3.30that there is a documented need within the parameters established by the commissioner
3.31for all component customized living services authorized.
3.32(b) The payment rate must be based on the amount of component services to be
3.33provided utilizing component rates established by the commissioner. Counties and tribes
3.34shall use tools issued by the commissioner to develop and document customized living
3.35service plans and rates.
4.1(c) Component service rates must not exceed payment rates for comparable elderly
4.2waiver or medical assistance services and must reflect economies of scale. Customized
4.3living services must not include rent or raw food costs.
4.4 (d) The individualized monthly authorized payment for the customized living
4.5service plan shall not exceed 50 percent of the greater of either the statewide or any
4.6of the geographic groups' weighted average monthly nursing facility rate of the case
4.7mix resident class to which the elderly waiver eligible client would be assigned under
4.8Minnesota Rules, parts 9549.0050 to 9549.0059, less the maintenance needs allowance
4.9as described in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in
4.10which the resident assessment system as described in section256B.438 for nursing
4.11home rate determination is implemented. Effective on July 1 of the state fiscal year in
4.12which the resident assessment system as described in section256B.438 for nursing
4.13home rate determination is implemented and July 1 of each subsequent state fiscal year,
4.14the individualized monthly authorized payment for the services described in this clause
4.15shall not exceed the limit which was in effect on June 30 of the previous state fiscal year
4.16updated annually based on legislatively adopted changes to all service rate maximums for
4.17home and community-based service providers.
4.18 (e) Customized living services are delivered by a provider licensed by the
4.19Department of Health as a class A or class F home care provider and provided in a
4.20building that is registered as a housing with services establishment under chapter 144D.
4.21 Sec. 3. Minnesota Statutes 2010, section 256B.0915, subdivision 3h, is amended to
4.22read:
4.23 Subd. 3h. Service rate limits; 24-hour customized living services. (a) The
4.24payment rate for 24-hour customized living services is a monthly rate authorized by the
4.25lead agency within the parameters established by the commissioner of human services.
4.26The payment agreement must delineate the amount of each component service included
4.27in each recipient's customized living service plan. The lead agency, in consultation with
4.28the provider of customized living services, shall ensure that there is a documented need
4.29within the parameters established by the commissioner for all component customized
4.30living services authorized. The lead agency shall not authorize 24-hour customized living
4.31services unless there is a documented need for 24-hour supervision.
4.32(b) For purposes of this section, "24-hour supervision" means that the recipient
4.33requires assistance due to needs related to one or more of the following:
4.34 (1) intermittent assistance with toileting, positioning, or transferring;
4.35 (2) cognitive or behavioral issues;
5.1 (3) a medical condition that requires clinical monitoring; or
5.2 (4) for all new participants enrolled in the program on or after January 1, 2011,
5.3and all other participants at their first reassessment after January 1, 2011, dependency
5.4in at least two of the following activities of daily living as determined by assessment
5.5under section256B.0911 : bathing; dressing; grooming; walking; or eating; and needs
5.6medication management and at least 50 hours of service per month. The lead agency shall
5.7ensure that the frequency and mode of supervision of the recipient and the qualifications
5.8of staff providing supervision are described and meet the needs of the recipient.
5.9(c) The payment rate for 24-hour customized living services must be based on the
5.10amount of component services to be provided utilizing component rates established by the
5.11commissioner. Counties and tribes will use tools issued by the commissioner to develop
5.12and document customized living plans and authorize rates.
5.13(d) Component service rates must not exceed payment rates for comparable elderly
5.14waiver or medical assistance services and must reflect economies of scale.
5.15(e) The individually authorized 24-hour customized living payments, in combination
5.16with the payment for other elderly waiver services, including case management, must not
5.17exceed the recipient's community budget cap specified in subdivision 3a. Customized
5.18living services must not include rent or raw food costs.
5.19(f) The individually authorized 24-hour customized living payment rates shall not
5.20exceed the 95 percentile of statewide monthly authorizations for 24-hour customized
5.21living services in effect and in the Medicaid management information systems on March
5.2231, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050
5.23to 9549.0059, to which elderly waiver service clients are assigned. When there are
5.24fewer than 50 authorizations in effect in the case mix resident class, the commissioner
5.25shall multiply the calculated service payment rate maximum for the A classification by
5.26the standard weight for that classification under Minnesota Rules, parts 9549.0050 to
5.279549.0059, to determine the applicable payment rate maximum. Service payment rate
5.28maximums shall be updated annually based on legislatively adopted changes to all service
5.29rates for home and community-based service providers.
5.30 (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner
5.31may establish alternative payment rate systems for 24-hour customized living services in
5.32housing with services establishments which are freestanding buildings with a capacity of
5.3316 or fewer, by applying a single hourly rate for covered component services provided
5.34in either:
5.35 (1) licensed corporate adult foster homes; or
6.1 (2) specialized dementia care units which meet the requirements of section144D.065
6.2and in which:
6.3 (i) each resident is offered the option of having their own apartment; or
6.4 (ii) the units are licensed as board and lodge establishments with maximum capacity
6.5of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
6.6subparts 1, 2, 3, and 4, item A.
6.7 Sec. 4. Minnesota Statutes 2010, section 256B.0915, subdivision 5, is amended to read:
6.8 Subd. 5. Assessments and reassessments for waiver clients. (a) Each client
6.9shall receive an initial assessment of strengths, informal supports, and need for services
6.10in accordance with section256B.0911, subdivisions 3, 3a, and 3b . A reassessment of a
6.11client served under the elderly waiver must be conducted at least every 12 months and at
6.12other times when the case manager determines that there has been significant change in
6.13the client's functioning. This may include instances where the client is discharged from
6.14the hospital. There must be a determination that the client requires nursing facility level of
6.15care as defined in section144.0724, subdivision 11 , at initial and subsequent assessments
6.16to initiate and maintain participation in the waiver program.
6.17(b) Regardless of other assessments identified in section144.0724, subdivision
6.184, as appropriate to determine nursing facility level of care for purposes of medical
6.19assistance payment for nursing facility services, only face-to-face assessments conducted
6.20according to section256B.0911, subdivisions 3a and 3b, that result in a nursing facility
6.21level of care determination will be accepted for purposes of initial and ongoing access to
6.22waiver service payment.
6.23(c) Notwithstanding section 256.045, subdivision 3, paragraph (a), clause (11), the
6.24person, the person's representative, or the provider of services under this section shall
6.25have the right to appeal determinations made under subdivisions 3e and 3h. Areas that
6.26may be appealed include, but are not limited to: care plans, service plans, determined
6.27rates, allocated service times, and case-mix classification assessments made under section
6.28256B.0911, subdivision 3a. Lead agencies shall have time for corrective action before a
6.29hearing under section 256.045, subdivision 3. Findings shall be retroactive to the date
6.30of the appeal filing.
6.31(d) The person, the person's representative, or the provider of services under this
6.32section shall have the right to request a reassessment of needed services. The reassessment
6.33shall be completed within ten working days.
6.34 Sec. 5. Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to read:
7.1 Subd. 6. Implementation of care plan. Each elderly waiver client, and the
7.2client's provider of services, shall be provided a copy of a written care plan that meets
7.3the requirements outlined in section256B.0913, subdivision 8 . The care plan must be
7.4implemented by the county of service when it is different than the county of financial
7.5responsibility. The county of service administering waivered services must notify the
7.6county of financial responsibility of the approved care plan.
7.7 Sec. 6. Minnesota Statutes 2010, section 256B.0915, subdivision 10, is amended to
7.8read:
7.9 Subd. 10. Waiver payment rates; managed care organizations. (a) The
7.10commissioner shall adjust the elderly waiver capitation payment rates for managed care
7.11organizations paid under section256B.69, subdivisions 6a and 23, to reflect the maximum
7.12service rate limits for customized living services and 24-hour customized living services
7.13under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical
7.14assistance rates paid to customized living providers by managed care organizations
7.15under this section shall not exceed the maximum service rate limits determined by the
7.16commissioner under subdivisions 3e and 3h.
7.17(b) Medical assistance customized living benefits under subdivision 3e, paragraph
7.18(e), shall be effective retroactive to the date of the long-term care assessment that
7.19establishes the needed level of services. This subdivision applies to both initial
7.20assessments and reassessments.
7.21(c) Managed care organizations must provide training and notification to providers
7.22of customized living services on systems and policy changes to eligibility, billing, and
7.23payment no less than 90 days prior to the change.
7.24(d) The person eligible for customized living benefits under subdivision 3e,
7.25paragraph (e), may choose to receive services from any provider that meets the standards
7.26approved in the home and community-based services waiver for the elderly, authorized
7.27under section 1915(c) of the Social Security Act.
7.28(e) The person receiving services in this section with a spenddown may choose to
7.29make their provider of services under this section a designated provider to whom they
7.30will pay their spenddown amount.
1.3elderly waiver;amending Minnesota Statutes 2010, sections 256B.0911,
1.4subdivision 3a; 256B.0915, subdivisions 3e, 3h, 5, 6, 10.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to
1.7read:
1.8 Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
1.9services planning, or other assistance intended to support community-based living,
1.10including persons who need assessment in order to determine waiver or alternative care
1.11program eligibility, must be visited by a long-term care consultation team within 15
1.12calendar days after the date on which an assessment was requested or recommended. After
1.13January 1, 2011, these requirements also apply to personal care assistance services, private
1.14duty nursing, and home health agency services, on timelines established in subdivision 5.
1.15Face-to-face assessments must be conducted according to paragraphs (b) to (i).
1.16 (b) The county may utilize a team of either the social worker or public health nurse,
1.17or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
1.18assessment in a face-to-face interview. The consultation team members must confer
1.19regarding the most appropriate care for each individual screened or assessed.
1.20 (c) The assessment must be comprehensive and include a person-centered
1.21assessment of the health, psychological, functional, environmental, and social needs of
1.22referred individuals and provide information necessary to develop a support plan that
1.23meets the consumers needs, using an assessment form provided by the commissioner.
2.1 (d) The assessment must be conducted in a face-to-face interview with the person
2.2being assessed and the person's legal representative, as required by legally executed
2.3documents, and other individuals as requested by the person, including the person's
2.4chosen provider of customized living services under section 256B.0915, subdivision 3e,
2.5paragraph (e), who can provide information on the needs, strengths, and preferences of the
2.6person necessary to develop a support plan that ensures the person's health and safety
2.7
2.8 (e) The person, or the person's legal representative, must be provided with written
2.9recommendations for community-based services, including consumer-directed options,
2.10or institutional care that include documentation that the most cost-effective alternatives
2.11available were offered to the individual. For purposes of this requirement, "cost-effective
2.12alternatives" means community services and living arrangements that cost the same as or
2.13less than institutional care.
2.14 (f) If the person chooses to use community-based services, the person or the person's
2.15legal representative must be provided with a written community support plan, regardless
2.16of whether the individual is eligible for Minnesota health care programs. A person may
2.17request assistance in identifying community supports without participating in a complete
2.18assessment. Upon a request for assistance identifying community support, the person must
2.19be transferred or referred to the services available under sections
2.20and
2.21 (g) The person has the right to make the final decision between institutional
2.22placement and community placement after the recommendations have been provided,
2.23except as provided in subdivision 4a, paragraph (c).
2.24 (h) The team must give the person receiving assessment or support planning, or
2.25the person's legal representative, materials, and forms supplied by the commissioner
2.26containing the following information:
2.27 (1) the need for and purpose of preadmission screening if the person selects nursing
2.28facility placement;
2.29 (2) the role of the long-term care consultation assessment and support planning in
2.30waiver and alternative care program eligibility determination;
2.31 (3) information about Minnesota health care programs;
2.32 (4) the person's freedom to accept or reject the recommendations of the team;
2.33 (5) the person's right to confidentiality under the Minnesota Government Data
2.34Practices Act, chapter 13;
3.1 (6) the long-term care consultant's decision regarding the person's need for
3.2institutional level of care as determined under criteria established in section
3.3subdivision 11
3.4 (7) the person's right to appeal the decision regarding the need for nursing facility
3.5level of care or the county's final decisions regarding public programs eligibility according
3.6to section
3.7The person's chosen provider of customized living services under section 256B.0915,
3.8subdivision 3e, paragraph (e), must also be provided with a copy of the long-term care
3.9consultant's assessment as well as the decision regarding the person's need for institutional
3.10level of care as determined under criteria established in section 144.0724, subdivision 11,
3.11or 256B.092.
3.12 (i) Face-to-face assessment completed as part of eligibility determination for
3.13the alternative care, elderly waiver, community alternatives for disabled individuals,
3.14community alternative care, and traumatic brain injury waiver programs under sections
3.16than 60 calendar days after the date of assessment. The effective eligibility start date
3.17for these programs can never be prior to the date of assessment. If an assessment was
3.18completed more than 60 days before the effective waiver or alternative care program
3.19eligibility start date, assessment and support plan information must be updated in a
3.20face-to-face visit and documented in the department's Medicaid Management Information
3.21System (MMIS). The effective date of program eligibility in this case cannot be prior to
3.22the date the updated assessment is completed.
3.23 Sec. 2. Minnesota Statutes 2010, section 256B.0915, subdivision 3e, is amended to
3.24read:
3.25 Subd. 3e. Customized living service rate. (a) Payment for customized living
3.26services shall be a monthly rate authorized by the lead agency within the parameters
3.27established by the commissioner. The payment agreement must delineate the amount of
3.28each component service included in the recipient's customized living service plan. The
3.29lead agency, in consultation with the provider of customized living services, shall ensure
3.30that there is a documented need within the parameters established by the commissioner
3.31for all component customized living services authorized.
3.32(b) The payment rate must be based on the amount of component services to be
3.33provided utilizing component rates established by the commissioner. Counties and tribes
3.34shall use tools issued by the commissioner to develop and document customized living
3.35service plans and rates.
4.1(c) Component service rates must not exceed payment rates for comparable elderly
4.2waiver or medical assistance services and must reflect economies of scale. Customized
4.3living services must not include rent or raw food costs.
4.4 (d) The individualized monthly authorized payment for the customized living
4.5service plan shall not exceed 50 percent of the greater of either the statewide or any
4.6of the geographic groups' weighted average monthly nursing facility rate of the case
4.7mix resident class to which the elderly waiver eligible client would be assigned under
4.8Minnesota Rules, parts 9549.0050 to 9549.0059, less the maintenance needs allowance
4.9as described in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in
4.10which the resident assessment system as described in section
4.11home rate determination is implemented. Effective on July 1 of the state fiscal year in
4.12which the resident assessment system as described in section
4.13home rate determination is implemented and July 1 of each subsequent state fiscal year,
4.14the individualized monthly authorized payment for the services described in this clause
4.15shall not exceed the limit which was in effect on June 30 of the previous state fiscal year
4.16updated annually based on legislatively adopted changes to all service rate maximums for
4.17home and community-based service providers.
4.18 (e) Customized living services are delivered by a provider licensed by the
4.19Department of Health as a class A or class F home care provider and provided in a
4.20building that is registered as a housing with services establishment under chapter 144D.
4.21 Sec. 3. Minnesota Statutes 2010, section 256B.0915, subdivision 3h, is amended to
4.22read:
4.23 Subd. 3h. Service rate limits; 24-hour customized living services. (a) The
4.24payment rate for 24-hour customized living services is a monthly rate authorized by the
4.25lead agency within the parameters established by the commissioner of human services.
4.26The payment agreement must delineate the amount of each component service included
4.27in each recipient's customized living service plan. The lead agency, in consultation with
4.28the provider of customized living services, shall ensure that there is a documented need
4.29within the parameters established by the commissioner for all component customized
4.30living services authorized. The lead agency shall not authorize 24-hour customized living
4.31services unless there is a documented need for 24-hour supervision.
4.32(b) For purposes of this section, "24-hour supervision" means that the recipient
4.33requires assistance due to needs related to one or more of the following:
4.34 (1) intermittent assistance with toileting, positioning, or transferring;
4.35 (2) cognitive or behavioral issues;
5.1 (3) a medical condition that requires clinical monitoring; or
5.2 (4) for all new participants enrolled in the program on or after January 1, 2011,
5.3and all other participants at their first reassessment after January 1, 2011, dependency
5.4in at least two of the following activities of daily living as determined by assessment
5.5under section
5.6medication management and at least 50 hours of service per month. The lead agency shall
5.7ensure that the frequency and mode of supervision of the recipient and the qualifications
5.8of staff providing supervision are described and meet the needs of the recipient.
5.9(c) The payment rate for 24-hour customized living services must be based on the
5.10amount of component services to be provided utilizing component rates established by the
5.11commissioner. Counties and tribes will use tools issued by the commissioner to develop
5.12and document customized living plans and authorize rates.
5.13(d) Component service rates must not exceed payment rates for comparable elderly
5.14waiver or medical assistance services and must reflect economies of scale.
5.15(e) The individually authorized 24-hour customized living payments, in combination
5.16with the payment for other elderly waiver services, including case management, must not
5.17exceed the recipient's community budget cap specified in subdivision 3a. Customized
5.18living services must not include rent or raw food costs.
5.19(f) The individually authorized 24-hour customized living payment rates shall not
5.20exceed the 95 percentile of statewide monthly authorizations for 24-hour customized
5.21living services in effect and in the Medicaid management information systems on March
5.2231, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050
5.23to 9549.0059, to which elderly waiver service clients are assigned. When there are
5.24fewer than 50 authorizations in effect in the case mix resident class, the commissioner
5.25shall multiply the calculated service payment rate maximum for the A classification by
5.26the standard weight for that classification under Minnesota Rules, parts 9549.0050 to
5.279549.0059, to determine the applicable payment rate maximum. Service payment rate
5.28maximums shall be updated annually based on legislatively adopted changes to all service
5.29rates for home and community-based service providers.
5.30 (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner
5.31may establish alternative payment rate systems for 24-hour customized living services in
5.32housing with services establishments which are freestanding buildings with a capacity of
5.3316 or fewer, by applying a single hourly rate for covered component services provided
5.34in either:
5.35 (1) licensed corporate adult foster homes; or
6.1 (2) specialized dementia care units which meet the requirements of section
6.3 (i) each resident is offered the option of having their own apartment; or
6.4 (ii) the units are licensed as board and lodge establishments with maximum capacity
6.5of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
6.6subparts 1, 2, 3, and 4, item A.
6.7 Sec. 4. Minnesota Statutes 2010, section 256B.0915, subdivision 5, is amended to read:
6.8 Subd. 5. Assessments and reassessments for waiver clients. (a) Each client
6.9shall receive an initial assessment of strengths, informal supports, and need for services
6.10in accordance with section
6.11client served under the elderly waiver must be conducted at least every 12 months and at
6.12other times when the case manager determines that there has been significant change in
6.13the client's functioning. This may include instances where the client is discharged from
6.14the hospital. There must be a determination that the client requires nursing facility level of
6.15care as defined in section
6.16to initiate and maintain participation in the waiver program.
6.17(b) Regardless of other assessments identified in section
6.19assistance payment for nursing facility services, only face-to-face assessments conducted
6.20according to section
6.21level of care determination will be accepted for purposes of initial and ongoing access to
6.22waiver service payment.
6.23(c) Notwithstanding section 256.045, subdivision 3, paragraph (a), clause (11), the
6.24person, the person's representative, or the provider of services under this section shall
6.25have the right to appeal determinations made under subdivisions 3e and 3h. Areas that
6.26may be appealed include, but are not limited to: care plans, service plans, determined
6.27rates, allocated service times, and case-mix classification assessments made under section
6.28256B.0911, subdivision 3a. Lead agencies shall have time for corrective action before a
6.29hearing under section 256.045, subdivision 3. Findings shall be retroactive to the date
6.30of the appeal filing.
6.31(d) The person, the person's representative, or the provider of services under this
6.32section shall have the right to request a reassessment of needed services. The reassessment
6.33shall be completed within ten working days.
6.34 Sec. 5. Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to read:
7.1 Subd. 6. Implementation of care plan. Each elderly waiver client, and the
7.2client's provider of services, shall be provided a copy of a written care plan that meets
7.3the requirements outlined in section
7.4implemented by the county of service when it is different than the county of financial
7.5responsibility. The county of service administering waivered services must notify the
7.6county of financial responsibility of the approved care plan.
7.7 Sec. 6. Minnesota Statutes 2010, section 256B.0915, subdivision 10, is amended to
7.8read:
7.9 Subd. 10. Waiver payment rates; managed care organizations. (a) The
7.10commissioner shall adjust the elderly waiver capitation payment rates for managed care
7.11organizations paid under section
7.12service rate limits for customized living services and 24-hour customized living services
7.13under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical
7.14assistance rates paid to customized living providers by managed care organizations
7.15under this section shall not exceed the maximum service rate limits determined by the
7.16commissioner under subdivisions 3e and 3h.
7.17(b) Medical assistance customized living benefits under subdivision 3e, paragraph
7.18(e), shall be effective retroactive to the date of the long-term care assessment that
7.19establishes the needed level of services. This subdivision applies to both initial
7.20assessments and reassessments.
7.21(c) Managed care organizations must provide training and notification to providers
7.22of customized living services on systems and policy changes to eligibility, billing, and
7.23payment no less than 90 days prior to the change.
7.24(d) The person eligible for customized living benefits under subdivision 3e,
7.25paragraph (e), may choose to receive services from any provider that meets the standards
7.26approved in the home and community-based services waiver for the elderly, authorized
7.27under section 1915(c) of the Social Security Act.
7.28(e) The person receiving services in this section with a spenddown may choose to
7.29make their provider of services under this section a designated provider to whom they
7.30will pay their spenddown amount.
