Bill Text: MN HF1406 | 2011-2012 | 87th Legislature | Engrossed

---

Bill Title: Continuing care provisions amended, telephone equipment program changed, disability service provisions changed, comprehensive assessments and case management services reformed, nursing facility provisions changed, and technical and conforming changes made.

Sponsorship: Partisan Bill (Republican 4)

Status: (Engrossed - Dead) 2011-05-21 - Senate conferees Nienow, Newman and Benson [HF1406 Detail]

Download: Minnesota-2011-HF1406-Engrossed.html

---

A bill for an act

relating to human services; amending continuing care policy provisions; making
changes to the telephone equipment program; making changes to disability
services provisions; reforming comprehensive assessments and case management
services; making changes to nursing facility provisions; making technical and
conforming changes; providing for rulemaking authority; requiring reports;
amending Minnesota Statutes 2010, sections 144A.071, subdivisions 3, 5a;
144D.08; 237.50; 237.51; 237.52; 237.53; 237.54; 237.55; 237.56; 245A.03,
subdivision 7; 245A.11, subdivision 8; 252.32, subdivision 1a; 252A.21,
subdivision 2; 256.476, subdivision 11; 256B.0625, subdivision 19c; 256B.0659,
subdivisions 1, 2, 3, 3a, 4, 9, 11, 13, 14, 19, 21, 30; 256B.0911, subdivisions 1,
1a, 2b, 2c, 3, 3a, 3b, 3c, 4a, 4c, 6; 256B.0913, subdivisions 7, 8; 256B.0915,
subdivisions 1a, 1b, 3c, 6, 10; 256B.0916, subdivision 7; 256B.092, subdivisions
1, 1a, 1b, 1e, 1g, 2, 3, 5, 7, 8, 8a, 9, 11; 256B.096, subdivision 5; 256B.19,
subdivision 1e; 256B.431, subdivision 2t; 256B.438, subdivisions 1, 3, 4, by
adding a subdivision; 256B.441, subdivision 55a; 256B.49, subdivisions 13, 14,
15, 21; 256B.4912; 256G.02, subdivision 6; proposing coding for new law in
Minnesota Statutes, chapter 252; repealing Minnesota Statutes 2010, section
144A.073, subdivisions 4, 5.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

TELEPHONE EQUIPMENT PROGRAM

    Section 1. Minnesota Statutes 2010, section 237.50, is amended to read:
237.50 DEFINITIONS.
    Subdivision 1. Scope. The terms used in sections 237.50 to 237.56 have the
meanings given them in this section.
    Subd. 3. Communication impaired disability. "Communication impaired
disability" means certified as deaf, severely hearing impaired, hard-of-hearing having
a hearing loss, speech impaired, deaf and blind disability, or mobility impaired if the
mobility impairment significantly impedes the ability physical disability that makes it
difficult or impossible to use standard customer premises telecommunications services
and equipment.
    Subd. 4. Communication device. "Communication device" means a device that
when connected to a telephone enables a communication-impaired person to communicate
with another person utilizing the telephone system. A "communication device" includes a
ring signaler, an amplification device, a telephone device for the deaf, a Brailling device
for use with a telephone, and any other device the Department of Human Services deems
necessary.
    Subd. 4a. Deaf. "Deaf" means a hearing impairment loss of such severity that the
individual must depend primarily upon visual communication such as writing, lip reading,
manual communication sign language, and gestures.
    Subd. 4b. Deafblind. "Deafblind" means any combination of vision and hearing
loss which interferes with acquiring information from the environment to the extent that
compensatory strategies and skills are necessary to access that or other information.
    Subd. 5. Exchange. "Exchange" means a unit area established and described by the
tariff of a telephone company for the administration of telephone service in a specified
geographical area, usually embracing a city, town, or village and its environs, and served
by one or more central offices, together with associated facilities used in providing
service within that area.
    Subd. 6. Fund. "Fund" means the telecommunications access Minnesota fund
established in section 237.52.
    Subd. 6a. Hard-of-hearing. "Hard-of-hearing" means a hearing impairment loss
resulting in a functional loss limitation, but not to the extent that the individual must
depend primarily upon visual communication.
    Subd. 7. Interexchange service. "Interexchange service" means telephone service
between points in two or more exchanges.
    Subd. 8. Inter-LATA interexchange service. "Inter-LATA interexchange service"
means interexchange service originating and terminating in different LATAs.
    Subd. 9. Local access and transport area. "Local access and transport area
(LATA)" means a geographical area designated by the Modification of Final Judgment
in U.S. v. Western Electric Co., Inc., 552 F. Supp. 131 (D.D.C. 1982), including
modifications in effect on the effective date of sections 237.51 to 237.54.
    Subd. 10. Local exchange service. "Local exchange service" means telephone
service between points within an exchange.
    Subd. 10a. Telecommunications device. "Telecommunications device" means
a device that (1) allows a person with a communication disability to have access to
telecommunications services as defined in subdivision 13, and (2) is specifically
selected by the Department of Human Services for its capacity to allow persons with
communication disabilities to use telecommunications services in a manner that is
functionally equivalent to the ability of an individual who does not have a communication
disability. A telecommunications device may include a ring signaler, an amplified
telephone, a hands-free telephone, a text telephone, a captioned telephone, a wireless
device, a device that produces Braille output for use with a telephone, and any other
device the Department of Human Services deems appropriate.
    Subd. 11. Telecommunication Telecommunications Relay service Services.
"Telecommunication Telecommunications Relay service Services" or "TRS" means
a central statewide service through which a communication-impaired person,
using a communication device, may send and receive messages to and from a
non-communication-impaired person whose telephone is not equipped with a
communication device and through which a non-communication-impaired person
may, by using voice communication, send and receive messages to and from a
communication-impaired person the telecommunications transmission services required
under Federal Communications Commission (FCC) regulations at Code of Federal
Regulations, title 47, sections 64.604 to 64.606. TRS allows an individual who has
a communication disability to use telecommunications services in a manner that is
functionally equivalent to the ability of an individual who does not have a communication
disability.
    Subd. 12. Telecommunications. "Telecommunications" means the transmission,
between or among points specified by the user, of information of the user's choosing,
without change in the form or content of the information as sent and received.
    Subd. 13. Telecommunications services. "Telecommunications services" means
the offering of telecommunications for fee directly to the public, or to such classes of users
as to be effectively available to the public, regardless of the facilities used.

    Sec. 2. Minnesota Statutes 2010, section 237.51, is amended to read:
237.51 TELECOMMUNICATIONS ACCESS MINNESOTA PROGRAM
ADMINISTRATION.
    Subdivision 1. Creation. The commissioner of commerce shall:
(1) administer through interagency agreement with the commissioner of human
services a program to distribute communication telecommunications devices to eligible
communication-impaired persons who have communication disabilities; and
(2) contract with a one or more qualified vendor vendors that serves
communication-impaired serve persons who have communication disabilities to create
and maintain a telecommunication provide telecommunications relay service services.
For purposes of sections 237.51 to 237.56, the Department of Commerce and any
organization with which it contracts pursuant to this section or section 237.54, subdivision
2 , are not telephone companies or telecommunications carriers as defined in section
237.01 .
    Subd. 5. Commissioner of commerce duties. In addition to any duties specified
elsewhere in sections 237.51 to 237.56, the commissioner of commerce shall:
(1) prepare the reports required by section 237.55;
(2) administer the fund created in section 237.52; and
(3) adopt rules under chapter 14 to implement the provisions of sections 237.50
to 237.56.
    Subd. 5a. Department Commissioner of human services duties. (a) In addition to
any duties specified elsewhere in sections 237.51 to 237.56, the commissioner of human
services shall:
(1) define economic hardship, special needs, and household criteria so as to
determine the priority of eligible applicants for initial distribution of devices and to
determine circumstances necessitating provision of more than one communication
telecommunications device per household;
(2) establish a method to verify eligibility requirements;
(3) establish specifications for communication telecommunications devices to be
purchased provided under section 237.53, subdivision 3; and
(4) inform the public and specifically the community of communication-impaired
persons who have communication disabilities of the program.; and
(5) provide devices based on the assessed need of eligible applicants.
(b) The commissioner may establish an advisory board to advise the department
in carrying out the duties specified in this section and to advise the commissioner of
commerce in carrying out duties under section 237.54. If so established, the advisory
board must include, at a minimum, the following communication-impaired persons:
(1) at least one member who is deaf;
(2) at least one member who is has a speech impaired disability;
(3) at least one member who is mobility impaired has a physical disability that
makes it difficult or impossible for the person to access telecommunications services; and
(4) at least one member who is hard-of-hearing.
The membership terms, compensation, and removal of members and the filling of
membership vacancies are governed by section 15.059. Advisory board meetings shall be
held at the discretion of the commissioner.

    Sec. 3. Minnesota Statutes 2010, section 237.52, is amended to read:
237.52 TELECOMMUNICATIONS ACCESS MINNESOTA FUND.
    Subdivision 1. Fund established. A telecommunications access Minnesota fund is
established as an account in the state treasury. Earnings, such as interest, dividends, and
any other earnings arising from fund assets, must be credited to the fund.
    Subd. 2. Assessment. (a) The commissioner of commerce, the commissioner
of employment and economic development, and the commissioner of human services
shall annually recommend to the Public Utilities Commission (PUC) an adequate and
appropriate surcharge and budget to implement sections 237.50 to 237.56, 248.062,
and 256C.30, respectively. The maximum annual budget for section 248.062 must not
exceed $100,000 and for section 256C.30 must not exceed $300,000. The Public Utilities
Commission shall review the budgets for reasonableness and may modify the budget
to the extent it is unreasonable. The commission shall annually determine the funding
mechanism to be used within 60 days of receipt of the recommendation of the departments
and shall order the imposition of surcharges effective on the earliest practicable date. The
commission shall establish a monthly charge no greater than 20 cents for each customer
access line, including trunk equivalents as designated by the commission pursuant to
section 403.11, subdivision 1.
(b) If the fund balance falls below a level capable of fully supporting all programs
eligible under subdivision 5 and sections 248.062 and 256C.30, expenditures under
sections 248.062 and 256C.30 shall be reduced on a pro rata basis and expenditures under
sections 237.53 and 237.54 shall be fully funded. Expenditures under sections 248.062
and 256C.30 shall resume at fully funded levels when the commissioner of commerce
determines there is a sufficient fund balance to fully fund those expenditures.
    Subd. 3. Collection. Every telephone company or communications carrier that
provides service provider of services capable of originating a telecommunications relay
TRS call, including cellular communications and other nonwire access services, in this
state shall collect the charges established by the commission under subdivision 2 and
transfer amounts collected to the commissioner of public safety in the same manner as
provided in section 403.11, subdivision 1, paragraph (d). The commissioner of public
safety must deposit the receipts in the fund established in subdivision 1.
    Subd. 4. Appropriation. Money in the fund is appropriated to the commissioner of
commerce to implement sections 237.51 to 237.56, to the commissioner of employment
and economic development to implement section 248.062, and to the commissioner of
human services to implement section 256C.30.
    Subd. 5. Expenditures. (a) Money in the fund may only be used for:
(1) expenses of the Department of Commerce, including personnel cost, public
relations, advisory board members' expenses, preparation of reports, and other reasonable
expenses not to exceed ten percent of total program expenditures;
(2) reimbursing the commissioner of human services for purchases made or services
provided pursuant to section 237.53;
(3) reimbursing telephone companies for purchases made or services provided
under section 237.53, subdivision 5; and
(4) contracting for establishment and operation of the telecommunication relay
service the provision of TRS required by section 237.54.
(b) All costs directly associated with the establishment of the program, the purchase
and distribution of communication telecommunications devices, and the establishment
and operation of the telecommunication relay service provision of TRS are either
reimbursable or directly payable from the fund after authorization by the commissioner
of commerce. The commissioner of commerce shall contract with the message relay
service operator one or more TRS providers to indemnify the local exchange carriers of
the relay telecommunications service providers for any fines imposed by the Federal
Communications Commission related to the failure of the relay service to comply with
federal service standards. Notwithstanding section 16A.41, the commissioner may
advance money to the contractor of the telecommunication relay service TRS providers if
the contractor establishes providers establish to the commissioner's satisfaction that the
advance payment is necessary for the operation provision of the service. The advance
payment may be used only for working capital reserve for the operation of the service.
The advance payment must be offset or repaid by the end of the contract fiscal year
together with interest accrued from the date of payment.

    Sec. 4. Minnesota Statutes 2010, section 237.53, is amended to read:
237.53 COMMUNICATION TELECOMMUNICATIONS DEVICE.
    Subdivision 1. Application. A person applying for a communication
telecommunications device under this section must apply to the program administrator on
a form prescribed by the Department of Human Services.
    Subd. 2. Eligibility. To be eligible to obtain a communication telecommunications
device under this section, a person must be:
(1) be able to benefit from and use the equipment for its intended purpose;
(2) have a communication impaired disability;
(3) be a resident of the state;
(4) be a resident in a household that has a median income at or below the applicable
median household income in the state, except a deaf and blind person who is deafblind
applying for a telebraille unit Braille device may reside in a household that has a median
income no more than 150 percent of the applicable median household income in the
state; and
(5) be a resident in a household that has telephone telecommunications service
or that has made application for service and has been assigned a telephone number; or
a resident in a residential care facility, such as a nursing home or group home where
telephone telecommunications service is not included as part of overall service provision.
    Subd. 3. Distribution. The commissioner of human services shall purchase and
distribute a sufficient number of communication telecommunications devices so that each
eligible household receives an appropriate device devices as determined under section
237.51, subdivision 5a. The commissioner of human services shall distribute the devices
to eligible households in each service area free of charge as determined under section
237.51, subdivision 5a.
    Subd. 4. Training; maintenance. The commissioner of human services shall
maintain the communication telecommunications devices until the warranty period
expires, and provide training, without charge, to first-time users of the devices.
    Subd. 5. Wiring installation. If a communication-impaired person is not served by
telephone service and is subject to economic hardship as determined by the Department
of Human Services, the telephone company providing local service shall at the direction
of the administrator of the program install necessary outside wiring without charge to
the household.
    Subd. 6. Ownership. All communication Telecommunications devices purchased
pursuant to subdivision 3 will become are the property of the state of Minnesota. Policies
and procedures for the return of devices from individuals who withdraw from the program
or whose eligibility status changes shall be determined by the commissioner of human
services.
    Subd. 7. Standards. The communication telecommunications devices distributed
under this section must comply with the electronic industries association alliance standards
and be approved by the Federal Communications Commission. The commissioner of
human services must provide each eligible person a choice of several models of devices,
the retail value of which may not exceed $600 for a communication device for the deaf
text telephone, and a retail value of $7,000 for a telebraille Braille device, or an amount
authorized by the Department of Human Services for a telephone device for the deaf with
auxiliary equipment all other telecommunications devices and auxiliary equipment it
deems cost-effective and appropriate to distribute according to sections 237.51 to 237.56.

    Sec. 5. Minnesota Statutes 2010, section 237.54, is amended to read:
237.54 TELECOMMUNICATION TELECOMMUNICATIONS RELAY
SERVICE SERVICES (TRS).
    Subd. 2. Operation. (a) The commissioner of commerce shall contract with
a one or more qualified vendor vendors for the operation and maintenance of the
telecommunication relay system provision of Telecommunications Relay Services (TRS).
(b) The telecommunication relay service provider TRS providers shall operate the
relay service within the state of Minnesota. The operator of the system TRS providers
shall keep all messages confidential, shall train personnel in the unique needs of
communication-impaired people, and shall inform communication-impaired persons
and the public of the availability and use of the system. Except in the case of a speech-
or mobility-impaired person, the operator shall not relay a message unless it originates
or terminates through a communication device for the deaf or a Brailling device for use
with a telephone comply with all current and subsequent FCC regulations at Code of
Federal Regulations, title 47, sections 64.601 to 64.606, and shall inform persons who
have communication disabilities and the public of the availability and use of TRS.

    Sec. 6. Minnesota Statutes 2010, section 237.55, is amended to read:
237.55 ANNUAL REPORT ON COMMUNICATION
TELECOMMUNICATIONS ACCESS.
The commissioner of commerce must prepare a report for presentation to the Public
Utilities Commission by January 31 of each year. Each report must review the accessibility
of the telephone system to communication-impaired persons, review the ability of
non-communication-impaired persons to communicate with communication-impaired
persons via the telephone system telecommunications services to persons who have
communication disabilities, describe services provided, account for money received and
disbursed annually annual revenues and expenditures for each aspect of the program fund
to date, and include predicted program future operation.

    Sec. 7. Minnesota Statutes 2010, section 237.56, is amended to read:
237.56 ADEQUATE SERVICE ENFORCEMENT.
The services required to be provided under sections 237.50 to 237.55 may be
enforced under section 237.081 upon a complaint of at least two communication-impaired
persons within the service area of any one telephone company telecommunications
service provider, provided that if only one person within the service area of a company
is receiving service under sections 237.50 to 237.55, the commission Public Utilities
Commission may proceed upon a complaint from that person.

ARTICLE 2

DISABILITY SERVICES

    Section 1. Minnesota Statutes 2010, section 245A.03, subdivision 7, is amended to
read:
    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
9555.6265, under this chapter for a physical location that will not be the primary residence
of the license holder for the entire period of licensure. If a license is issued during this
moratorium, and the license holder changes the license holder's primary residence away
from the physical location of the foster care license, the commissioner shall revoke the
license according to section 245A.07. Exceptions to the moratorium include:
(1) foster care settings that are required to be registered under chapter 144D;
(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
and determined to be needed by the commissioner under paragraph (b);
(3) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for the closure or downsizing of a nursing facility, ICF/MR, or regional
treatment center;
(4) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for persons requiring hospital level care; or
(5) new foster care licenses determined to be needed by the commissioner for the
transition of people from personal care assistance to the home and community-based
services.
(b) The commissioner shall determine the need for newly licensed foster care homes
as defined under this subdivision. As part of the determination, the commissioner shall
consider the availability of foster care capacity in the area in which the licensee seeks to
operate, and the recommendation of the local county board. The determination by the
commissioner must be final. A determination of need is not required for a change in
ownership at the same address.
    (c) Residential settings that would otherwise be subject to the moratorium established
in paragraph (a), that are in the process of receiving an adult or child foster care license as
of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult
or child foster care license. For this paragraph, all of the following conditions must be met
to be considered in the process of receiving an adult or child foster care license:
    (1) participants have made decisions to move into the residential setting, including
documentation in each participant's care plan;
    (2) the provider has purchased housing or has made a financial investment in the
property;
    (3) the lead agency has approved the plans, including costs for the residential setting
for each individual;
    (4) the completion of the licensing process, including all necessary inspections, is
the only remaining component prior to being able to provide services; and
    (5) the needs of the individuals cannot be met within the existing capacity in that
county.
To qualify for the process under this paragraph, the lead agency must submit
documentation to the commissioner by August 1, 2009, that all of the above criteria are
met.
(d) (c) The commissioner shall study the effects of the license moratorium under this
subdivision and shall report back to the legislature by January 15, 2011. This study shall
include, but is not limited to the following:
(1) the overall capacity and utilization of foster care beds where the physical location
is not the primary residence of the license holder prior to and after implementation
of the moratorium;
(2) the overall capacity and utilization of foster care beds where the physical
location is the primary residence of the license holder prior to and after implementation
of the moratorium; and
(3) the number of licensed and occupied ICF/MR beds prior to and after
implementation of the moratorium.
(d) At the time of application and reapplication for licensure, the applicant and the
license holder that are subject to the moratorium or an exclusion established in paragraph
(a) are required to inform the commissioner whether the physical location where the foster
care will be provided is or will be the primary residence of the license holder for the entire
period of licensure. If the primary residence of the applicant or license holder changes, the
applicant or license holder must notify the commissioner immediately. The commissioner
shall print on the foster care license certificate whether or not the physical location is the
primary residence of the license holder.
(e) License holders of foster care homes identified under paragraph (e) that are not
the primary residence of the license holder and that also provide services in the foster care
home that are covered by a federally approved home and community-based services
waiver, as authorized under section 256B.0915, 256B.092, or 256B.49 must inform the
human services licensing division that the license holder provides or intends to provide
these waiver-funded services. These license holders must be considered registered under
section 256B.092, subdivision 11, paragraph (c), and this registration status must be
identified on their license certificates.

    Sec. 2. Minnesota Statutes 2010, section 245A.11, subdivision 8, is amended to read:
    Subd. 8. Community residential setting license. (a) The commissioner shall
establish provider standards for residential support services that integrate service standards
and the residential setting under one license. The commissioner shall propose statutory
language and an implementation plan for licensing requirements for residential support
services to the legislature by January 15, 2011 2012, as a component of the quality outcome
standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
for services in settings licensed as adult foster care under Minnesota Rules, parts
9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to
2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph
(b), must be required to obtain a community residential setting license.

    Sec. 3. Minnesota Statutes 2010, section 252.32, subdivision 1a, is amended to read:
    Subd. 1a. Support grants. (a) Provision of support grants must be limited to
families who require support and whose dependents are under the age of 21 and who
have been certified disabled under section 256B.055, subdivision 12, paragraphs (a),
(b), (c), (d), and (e). Families who are receiving: home and community-based waivered
services for persons with developmental disabilities authorized under section 256B.092 or
256B.49; personal care assistance under section 256B.0652; or a consumer support grant
under section 256.476 are not eligible for support grants.
Families whose annual adjusted gross income is $60,000 or more are not eligible for
support grants except in cases where extreme hardship is demonstrated. Beginning in state
fiscal year 1994, the commissioner shall adjust the income ceiling annually to reflect the
projected change in the average value in the United States Department of Labor Bureau of
Labor Statistics Consumer Price Index (all urban) for that year.
(b) Support grants may be made available as monthly subsidy grants and lump-sum
grants.
(c) Support grants may be issued in the form of cash, voucher, and direct county
payment to a vendor.
(d) Applications for the support grant shall be made by the legal guardian to the
county social service agency. The application shall specify the needs of the families, the
form of the grant requested by the families, and the items and services to be reimbursed.

    Sec. 4. [252.34] REPORT BY COMMISSIONER.
Beginning January 1, 2013, the commissioner shall provide a biennial report to the
chairs of the legislative committees with jurisdiction over health and human services
policy and funding. The report must provide a summary of overarching goals and priorities
for persons with disabilities, including the status of how each of the following programs
administered by the commissioner is supporting the overarching goals and priorities:
(1) home and community-based services waivers for persons with disabilities under
sections 256B.092 and 256B.49;
(2) home care services under section 256B.0652; and
(3) other relevant programs and services as determined by the commissioner.

    Sec. 5. Minnesota Statutes 2010, section 252A.21, subdivision 2, is amended to read:
    Subd. 2. Rules. The commissioner shall adopt rules to implement this chapter.
The rules must include standards for performance of guardianship or conservatorship
duties including, but not limited to: twice a year visits with the ward; quarterly reviews
of records from day, residential, and support services; a requirement that the duties of
guardianship or conservatorship and case management not be performed by the same
person; specific standards for action on "do not resuscitate" orders, sterilization requests,
and the use of psychotropic medication and aversive procedures.

    Sec. 6. Minnesota Statutes 2010, section 256.476, subdivision 11, is amended to read:
    Subd. 11. Consumer support grant program after July 1, 2001. Effective
July 1, 2001, the commissioner shall allocate consumer support grant resources to
serve additional individuals based on a review of Medicaid authorization and payment
information of persons eligible for a consumer support grant from the most recent fiscal
year. The commissioner shall use the following methodology to calculate maximum
allowable monthly consumer support grant levels:
    (1) For individuals whose program of origination is medical assistance home care
under sections 256B.0651 and 256B.0653 to 256B.0656, the maximum allowable monthly
grant levels are calculated by:
    (i) determining 50 percent of the average the service authorization for each
individual based on the individual's home care rating assessment;
    (ii) calculating the overall ratio of actual payments to service authorizations by
program;
    (iii) applying the overall ratio to the average 50 percent of the service authorization
level of each home care rating; and
    (iv) adjusting the result for any authorized rate increases changes provided by the
legislature; and.
    (v) adjusting the result for the average monthly utilization per recipient.
    (2) The commissioner may review and evaluate shall ensure the methodology to
reflect changes in is consistent with the home care programs.

    Sec. 7. Minnesota Statutes 2010, section 256B.0625, subdivision 19c, is amended to
read:
    Subd. 19c. Personal care. Medical assistance covers personal care assistance
services provided by an individual who is qualified to provide the services according to
subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
plan, and supervised by a qualified professional.
"Qualified professional" means a mental health professional as defined in section
245.462, subdivision 18 , clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6);
or a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker
as defined in sections 148D.010 and 148D.055, or a qualified developmental disabilities
specialist under section 245B.07, subdivision 4. The qualified professional shall perform
the duties required in section 256B.0659.

    Sec. 8. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to read:
    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
    (b) "Activities of daily living" means grooming, dressing, bathing, transferring,
mobility, positioning, eating, and toileting.
    (c) "Behavior," effective January 1, 2010, means a category to determine the home
care rating and is based on the criteria found in this section. "Level I behavior" means
physical aggression towards self, others, or destruction of property that requires the
immediate response of another person.
    (d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.
    (e) "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.
    (f) "Dependency in activities of daily living" means a person requires assistance to
begin and complete one or more of the activities of daily living.
    (g) "Extended personal care assistance service" means personal care assistance
services included in a service plan under one of the home and community-based services
waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49,
which exceed the amount, duration, and frequency of the state plan personal care
assistance services for participants who:
    (1) need assistance provided periodically during a week, but less than daily will not
be able to remain in their homes without the assistance, and other replacement services
are more expensive or are not available when personal care assistance services are to
be terminated reduced; or
    (2) need additional personal care assistance services beyond the amount authorized
by the state plan personal care assistance assessment in order to ensure that their safety,
health, and welfare are provided for in their homes.
    (h) "Health-related procedures and tasks" means procedures and tasks that can
be delegated or assigned by a licensed health care professional under state law to be
performed by a personal care assistant.
    (i) "Instrumental activities of daily living" means activities to include meal planning
and preparation; basic assistance with paying bills; shopping for food, clothing, and other
essential items; performing household tasks integral to the personal care assistance
services; communication by telephone and other media; and traveling, including to
medical appointments and to participate in the community.
    (j) "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.
    (k) "Qualified professional" means a professional providing supervision of personal
care assistance services and staff as defined in section 256B.0625, subdivision 19c.
    (l) "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and
includes a personal care assistance provider organization, personal care assistance choice
agency, class A licensed nursing agency, and Medicare-certified home health agency.
    (m) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.
    (n) "Personal care assistance care plan" means a written description of personal
care assistance services developed by the personal care assistance provider according
to the service plan.
    (o) "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.
    (p) "Self-administered medication" means medication taken orally, by injection or
insertion, or applied topically without the need for assistance.
    (q) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.
    (r) "Wages and benefits" means wages and salaries, the employer's share of FICA
taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, and contributions to employee retirement
accounts.

    Sec. 9. Minnesota Statutes 2010, section 256B.0659, subdivision 3, is amended to read:
    Subd. 3. Noncovered personal care assistance services. (a) Personal care
assistance services are not eligible for medical assistance payment under this section
when provided:
    (1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
guardian, licensed foster provider, except as allowed under section 256B.0652, subdivision
10 , or responsible party;
    (2) in lieu of other staffing options order to meet staffing or license requirements in a
residential or child care setting;
    (3) solely as a child care or babysitting service; or
    (4) without authorization by the commissioner or the commissioner's designee.
    (b) The following personal care services are not eligible for medical assistance
payment under this section when provided in residential settings:
    (1) effective January 1, 2010, when the provider of home care services who is not
related by blood, marriage, or adoption owns or otherwise controls the living arrangement,
including licensed or unlicensed services; or
    (2) when personal care assistance services are the responsibility of a residential or
program license holder under the terms of a service agreement and administrative rules.
    (c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
for medical assistance reimbursement for personal care assistance services under this
section include:
    (1) sterile procedures;
    (2) injections of fluids and medications into veins, muscles, or skin;
    (3) home maintenance or chore services;
    (4) homemaker services not an integral part of assessed personal care assistance
services needed by a recipient;
    (5) application of restraints or implementation of procedures under section 245.825;
    (6) instrumental activities of daily living for children under the age of 18, except
when immediate attention is needed for health or hygiene reasons integral to the personal
care services and the need is listed in the service plan by the assessor; and
    (7) assessments for personal care assistance services by personal care assistance
provider agencies or by independently enrolled registered nurses.

    Sec. 10. Minnesota Statutes 2010, section 256B.0659, subdivision 9, is amended to
read:
    Subd. 9. Responsible party; generally. (a) "Responsible party" means an
individual who is capable of providing the support necessary to assist the recipient to live
in the community.
(b) A responsible party must be 18 years of age, actively participate in planning and
directing of personal care assistance services, and attend all assessments for the recipient.
(c) A responsible party must not be the:
(1) personal care assistant;
(2) qualified professional;
(3) home care provider agency owner or staff manager; or
(4) home care provider agency staff unless staff who are not listed in clauses (1) to
(3) are related to the recipient by blood, marriage, or adoption; or
(3) (5) county staff acting as part of employment.
(d) A licensed family foster parent who lives with the recipient may be the
responsible party as long as the family foster parent meets the other responsible party
requirements.
(e) A responsible party is required when:
(1) the person is a minor according to section 524.5-102, subdivision 10;
(2) the person is an incapacitated adult according to section 524.5-102, subdivision
6 , resulting in a court-appointed guardian; or
(3) the assessment according to subdivision 3a determines that the recipient is in
need of a responsible party to direct the recipient's care.
(f) There may be two persons designated as the responsible party for reasons such
as divided households and court-ordered custodies. Each person named as responsible
party must meet the program criteria and responsibilities.
(g) The recipient or the recipient's legal representative shall appoint a responsible
party if necessary to direct and supervise the care provided to the recipient. The
responsible party must be identified at the time of assessment and listed on the recipient's
service agreement and personal care assistance care plan.

    Sec. 11. Minnesota Statutes 2010, section 256B.0659, subdivision 11, is amended to
read:
    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
must meet the following requirements:
    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years
of age with these additional requirements:
    (i) supervision by a qualified professional every 60 days; and
    (ii) employment by only one personal care assistance provider agency responsible
for compliance with current labor laws;
    (2) be employed by a personal care assistance provider agency;
    (3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:
    (i) not disqualified under section 245C.14; or
    (ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
    (4) be able to effectively communicate with the recipient and personal care
assistance provider agency;
    (5) be able to provide covered personal care assistance services according to the
recipient's personal care assistance care plan, respond appropriately to recipient needs,
and report changes in the recipient's condition to the supervising qualified professional
or physician;
    (6) not be a consumer of personal care assistance services;
    (7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;
    (8) effective January 1, 2010, complete standardized training as determined
by the commissioner before completing enrollment. The training must be available
in languages other than English and to those who need accommodations due to
disabilities. Personal care assistant training must include successful completion of the
following training components: basic first aid, vulnerable adult, child maltreatment,
OSHA universal precautions, basic roles and responsibilities of personal care assistants
including information about assistance with lifting and transfers for recipients, emergency
preparedness, orientation to positive behavioral practices, fraud issues, and completion of
time sheets. Upon completion of the training components, the personal care assistant must
demonstrate the competency to provide assistance to recipients;
    (9) complete training and orientation on the needs of the recipient within the first
seven days after the services begin; and
    (10) be limited to providing and being paid for up to 275 hours per month, except
that this limit shall be 275 hours per month for the period July 1, 2009, through June 30,
2011, of personal care assistance services regardless of the number of recipients being
served or the number of personal care assistance provider agencies enrolled with. The
number of hours worked per day shall not be disallowed by the department unless in
violation of the law.
    (b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).
    (c) Effective January 1, 2010, Persons who do not qualify as a personal care assistant
include parents and, stepparents, and legal guardians of minors,; spouses,; paid legal
guardians, of adults; family foster care providers, except as otherwise allowed in section
256B.0625, subdivision 19a , or; and staff of a residential setting.

    Sec. 12. Minnesota Statutes 2010, section 256B.0659, subdivision 13, is amended to
read:
    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
must work for a personal care assistance provider agency and meet the definition under
section 256B.0625, subdivision 19c. Before a qualified professional provides services, the
personal care assistance provider agency must initiate a background study on the qualified
professional under chapter 245C, and the personal care assistance provider agency must
have received a notice from the commissioner that the qualified professional:
    (1) is not disqualified under section 245C.14; or
    (2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.
    (b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of
personal care assistance services. The qualified professional shall:
    (1) develop and monitor with the recipient a personal care assistance care plan based
on the service plan and individualized needs of the recipient;
    (2) develop and monitor with the recipient a monthly plan for the use of personal
care assistance services;
    (3) review documentation of personal care assistance services provided;
    (4) provide training and ensure competency for the personal care assistant in the
individual needs of the recipient; and
    (5) document all training, communication, evaluations, and needed actions to
improve performance of the personal care assistants.
    (c) Effective July 1, 2010 2011, the qualified professional shall complete the provider
training with basic information about the personal care assistance program approved by
the commissioner. Newly hired qualified professionals must complete the training within
six months of the date hired by a personal care assistance provider agency. Qualified
professionals who have completed the required training as a worker from a personal care
assistance provider agency do not need to repeat the required training if they are hired
by another agency, if they have completed the training within the last three years. The
required training shall must be available in languages other than English and to those who
need accommodations due to disabilities, with meaningful access according to title VI of
the Civil Rights Act and federal regulations adopted under that law or any guidance from
the United States Health and Human Services Department. The required training must
be available online, or by electronic remote connection, and. The required training must
provide for competency testing to demonstrate an understanding of the content without
attending in-person training. A qualified professional is allowed to be employed and is not
subject to the training requirement until the training is offered online or through remote
electronic connection. A qualified professional employed by a personal care assistance
provider agency certified for participation in Medicare as a home health agency is exempt
from the training required in this subdivision. When available, the qualified professional
working for a Medicare-certified home health agency must successfully complete the
competency test. The commissioner shall ensure there is a mechanism in place to verify
the identity of persons completing the competency testing electronically.

    Sec. 13. Minnesota Statutes 2010, section 256B.0659, subdivision 14, is amended to
read:
    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal
care assistants must be supervised by a qualified professional.
    (b) Through direct training, observation, return demonstrations, and consultation
with the staff and the recipient, the qualified professional must ensure and document
that the personal care assistant is:
    (1) capable of providing the required personal care assistance services;
    (2) knowledgeable about the plan of personal care assistance services before services
are performed; and
    (3) able to identify conditions that should be immediately brought to the attention of
the qualified professional.
    (c) The qualified professional shall evaluate the personal care assistant within the
first 14 days of starting to provide regularly scheduled services for a recipient, or sooner as
determined by the qualified professional, except for the personal care assistance choice
option under subdivision 19, paragraph (a), clause (4). For the initial evaluation, the
qualified professional shall evaluate the personal care assistance services for a recipient
through direct observation of a personal care assistant's work. The qualified professional
may conduct additional training and evaluation visits, based upon the needs of the
recipient and the personal care assistant's ability to meet those needs. Subsequent visits to
evaluate the personal care assistance services provided to a recipient do not require direct
observation of each personal care assistant's work and shall occur:
    (1) at least every 90 days thereafter for the first year of a recipient's services;
    (2) every 120 days after the first year of a recipient's service or whenever needed for
response to a recipient's request for increased supervision of the personal care assistance
staff; and
    (3) after the first 180 days of a recipient's service, supervisory visits may alternate
between unscheduled phone or Internet technology and in-person visits, unless the
in-person visits are needed according to the care plan.
    (d) Communication with the recipient is a part of the evaluation process of the
personal care assistance staff.
    (e) At each supervisory visit, the qualified professional shall evaluate personal care
assistance services including the following information:
    (1) satisfaction level of the recipient with personal care assistance services;
    (2) review of the month-to-month plan for use of personal care assistance services;
    (3) review of documentation of personal care assistance services provided;
    (4) whether the personal care assistance services are meeting the goals of the service
as stated in the personal care assistance care plan and service plan;
    (5) a written record of the results of the evaluation and actions taken to correct any
deficiencies in the work of a personal care assistant; and
    (6) revision of the personal care assistance care plan as necessary in consultation
with the recipient or responsible party, to meet the needs of the recipient.
    (f) The qualified professional shall complete the required documentation in the
agency recipient and employee files and the recipient's home, including the following
documentation:
    (1) the personal care assistance care plan based on the service plan and individualized
needs of the recipient;
    (2) a month-to-month plan for use of personal care assistance services;
    (3) changes in need of the recipient requiring a change to the level of service and the
personal care assistance care plan;
    (4) evaluation results of supervision visits and identified issues with personal care
assistance staff with actions taken;
    (5) all communication with the recipient and personal care assistance staff; and
    (6) hands-on training or individualized training for the care of the recipient.
    (g) The documentation in paragraph (f) must be done on agency forms templates.
    (h) The services that are not eligible for payment as qualified professional services
include:
    (1) direct professional nursing tasks that could be assessed and authorized as skilled
nursing tasks;
    (2) supervision of personal care assistance completed by telephone;
    (3) (2) agency administrative activities;
    (4) (3) training other than the individualized training required to provide care for a
recipient; and
    (5) (4) any other activity that is not described in this section.

    Sec. 14. Minnesota Statutes 2010, section 256B.0659, subdivision 19, is amended to
read:
    Subd. 19. Personal care assistance choice option; qualifications; duties. (a)
Under personal care assistance choice, the recipient or responsible party shall:
    (1) recruit, hire, schedule, and terminate personal care assistants according to the
terms of the written agreement required under subdivision 20, paragraph (a);
    (2) develop a personal care assistance care plan based on the assessed needs
and addressing the health and safety of the recipient with the assistance of a qualified
professional as needed;
    (3) orient and train the personal care assistant with assistance as needed from the
qualified professional;
    (4) effective January 1, 2010, supervise and evaluate the personal care assistant with
the qualified professional, who is required to visit the recipient at least every 180 days;
    (5) monitor and verify in writing and report to the personal care assistance choice
agency the number of hours worked by the personal care assistant and the qualified
professional;
    (6) engage in an annual face-to-face reassessment to determine continuing eligibility
and service authorization; and
    (7) use the same personal care assistance choice provider agency if shared personal
assistance care is being used.
    (b) The personal care assistance choice provider agency shall:
    (1) meet all personal care assistance provider agency standards;
    (2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;
    (3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
professional, or the personal care assistant; and
    (4) ensure arm's-length transactions without undue influence or coercion with the
recipient and personal care assistant.
    (c) The duties of the personal care assistance choice provider agency are to:
    (1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations including, but not limited to, purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation including, but not
limited to, workers' compensation and unemployment insurance;
    (2) bill the medical assistance program for personal care assistance services and
qualified professional services;
    (3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;
    (4) pay the personal care assistant and qualified professional based on actual hours
of services provided;
    (5) withhold and pay all applicable federal and state taxes;
    (6) verify and keep records of hours worked by the personal care assistant and
qualified professional;
    (7) make the arrangements and pay taxes and other benefits, if any, and comply with
any legal requirements for a Minnesota employer;
    (8) enroll in the medical assistance program as a personal care assistance choice
agency; and
    (9) enter into a written agreement as specified in subdivision 20 before services
are provided.

    Sec. 15. Minnesota Statutes 2010, section 256B.0659, subdivision 21, is amended to
read:
    Subd. 21. Requirements for initial enrollment of personal care assistance
provider agencies. (a) All personal care assistance provider agencies must provide, at the
time of enrollment as a personal care assistance provider agency in a format determined
by the commissioner, information and documentation that includes, but is not limited to,
the following:
    (1) the personal care assistance provider agency's current contact information
including address, telephone number, and e-mail address;
    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;
    (3) proof of fidelity bond coverage in the amount of $20,000;
    (4) proof of workers' compensation insurance coverage;
    (5) proof of liability insurance;
    (6) a description of the personal care assistance provider agency's organization
identifying the names of all owners, managing employees, staff, board of directors, and
the affiliations of the directors, owners, or staff to other service providers;
    (7) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery;
and employee and consumer safety including process for notification and resolution
of consumer grievances, identification and prevention of communicable diseases, and
employee misconduct;
    (8) copies of all other forms the personal care assistance provider agency uses in
the course of daily business including, but not limited to:
    (i) a copy of the personal care assistance provider agency's time sheet if the time
sheet varies from the standard time sheet for personal care assistance services approved
by the commissioner, and a letter requesting approval of the personal care assistance
provider agency's nonstandard time sheet;
    (ii) the personal care assistance provider agency's template for the personal care
assistance care plan; and
    (iii) the personal care assistance provider agency's template for the written
agreement in subdivision 20 for recipients using the personal care assistance choice
option, if applicable;
    (9) a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;
    (10) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;
    (11) documentation of the agency's marketing practices;
    (12) disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services;
    (13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services
for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
personal care assistance choice option and 72.5 percent of revenue from other personal
care assistance providers; and
    (14) effective May 15, 2010, documentation that the agency does not burden
recipients' free exercise of their right to choose service providers by requiring personal
care assistants to sign an agreement not to work with any particular personal care
assistance recipient or for another personal care assistance provider agency after leaving
the agency and that the agency is not taking action on any such agreements or requirements
regardless of the date signed.
    (b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider
agency enrolls as a vendor or upon request from the commissioner. The commissioner
shall collect the information specified in paragraph (a) from all personal care assistance
providers beginning July 1, 2009.
    (c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training
as determined by the commissioner before enrollment of the agency as a provider.
Employees in management and supervisory positions and owners who are active in
the day-to-day operations of an agency who have completed the required training as
an employee with a personal care assistance provider agency do not need to repeat
the required training if they are hired by another agency, if they have completed the
training within the past three years. By September 1, 2010, the required training must be
available in languages other than English and to those who need accommodations due
to disabilities, with meaningful access according to title VI of the Civil Rights Act and
federal regulations adopted under that law or any guidance from the United States Health
and Human Services Department. The required training must be available online, or by
electronic remote connection, and. The required training must provide for competency
testing. Personal care assistance provider agency billing staff shall complete training about
personal care assistance program financial management. This training is effective July 1,
2009. Any personal care assistance provider agency enrolled before that date shall, if it
has not already, complete the provider training within 18 months of July 1, 2009. Any new
owners or employees in management and supervisory positions involved in the day-to-day
operations are required to complete mandatory training as a requisite of working for the
agency. Personal care assistance provider agencies certified for participation in Medicare
as home health agencies are exempt from the training required in this subdivision. When
available, Medicare-certified home health agency owners, supervisors, or managers must
successfully complete the competency test.

    Sec. 16. Minnesota Statutes 2010, section 256B.0659, subdivision 30, is amended to
read:
    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
    (1) by October 31, 2009, information to recipients likely to be affected that (i)
describes the changes to the personal care assistance program that may result in the
loss of access to personal care assistance services, and (ii) includes resources to obtain
further information;
    (2) effective through January 1, 2012, notice of changes in medical assistance
personal care assistance services to each affected recipient at least 30 days before the
effective date of the change.
The notice shall include how to get further information on the changes, how to get help to
obtain other services, a list of community resources, and appeal rights. Notwithstanding
section 256.045, a recipient may request continued services pending appeal within the
time period allowed to request an appeal; and
    (3) a service agreement authorizing personal care assistance hours of service at
the previously authorized level, throughout the appeal process period, when a recipient
requests services pending an appeal.

    Sec. 17. Minnesota Statutes 2010, section 256B.0916, subdivision 7, is amended to
read:
    Subd. 7. Annual report by commissioner. (a) Beginning November 1, 2001, and
each November 1 thereafter, the commissioner shall issue an annual report on county and
state use of available resources for the home and community-based waiver for persons with
developmental disabilities. For each county or county partnership, the report shall include:
(1) the amount of funds allocated but not used;
(2) the county specific allowed reserve amount approved and used;
(3) the number, ages, and living situations of individuals screened and waiting for
services;
(4) the urgency of need for services to begin within one, two, or more than two
years for each individual;
(5) the services needed;
(6) the number of additional persons served by approval of increased capacity within
existing allocations;
(7) results of action by the commissioner to streamline administrative requirements
and improve county resource management; and
(8) additional action that would decrease the number of those eligible and waiting
for waivered services.
The commissioner shall specify intended outcomes for the program and the degree to
which these specified outcomes are attained.
(b) This subdivision expires January 1, 2012.

    Sec. 18. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to
read:
    Subd. 11. Residential support services. (a) Upon federal approval, there is
established a new service called residential support that is available on the community
alternative care, community alternatives for disabled individuals, developmental
disabilities, and traumatic brain injury waivers. Existing waiver service descriptions
must be modified to the extent necessary to ensure there is no duplication between
other services. Residential support services must be provided by vendors licensed as a
community residential setting as defined in section 245A.11, subdivision 8.
(b) Residential support services must meet the following criteria:
(1) providers of residential support services must own or control the residential site;
(2) the residential site must not be the primary residence of the license holder;
(3) the residential site must have a designated program supervisor responsible for
program oversight, development, and implementation of policies and procedures;
(4) the provider of residential support services must provide supervision, training,
and assistance as described in the person's community support plan; and
(5) the provider of residential support services must meet the requirements of
licensure and additional requirements of the person's community support plan.
(c) Providers of residential support services that meet the definition in paragraph
(a) must be registered using a process determined by the commissioner beginning July
1, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts
2960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts
9555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision
7, paragraph (e), are considered registered under this section.

    Sec. 19. Minnesota Statutes 2010, section 256B.096, subdivision 5, is amended to read:
    Subd. 5. Biennial report. (a) The commissioner shall provide a biennial report to
the chairs of the legislative committees with jurisdiction over health and human services
policy and funding beginning January 15, 2009, on the development and activities of the
quality management, assurance, and improvement system designed to meet the federal
requirements under the home and community-based services waiver programs for persons
with disabilities. By January 15, 2008, the commissioner shall provide a preliminary
report on priorities for meeting the federal requirements, progress on development and
field testing of the annual survey, appropriations necessary to implement an annual survey
of service recipients once field testing is completed, recommendations for improvements
in the incident reporting system, and a plan for incorporating quality assurance efforts
under section 256B.095 and other regional efforts into the statewide system.
(b) This subdivision expires January 1, 2012.

    Sec. 20. Minnesota Statutes 2010, section 256B.49, subdivision 21, is amended to read:
    Subd. 21. Report. (a) The commissioner shall expand on the annual report required
under section 256B.0916, subdivision 7, to include information on the county of residence
and financial responsibility, age, and major diagnoses for persons eligible for the home
and community-based waivers authorized under subdivision 11 who are:
(1) receiving those services;
(2) screened and waiting for waiver services; and
(3) residing in nursing facilities and are under age 65.
(b) This subdivision expires January 1, 2012.

    Sec. 21. Minnesota Statutes 2010, section 256B.4912, is amended to read:
256B.4912 HOME AND COMMUNITY-BASED WAIVERS; PROVIDERS
AND PAYMENT.
    Subdivision 1. Provider qualifications. For the home and community-based
waivers providing services to seniors and individuals with disabilities, the commissioner
shall establish:
(1) agreements with enrolled waiver service providers to ensure providers meet
qualifications defined in the waiver plans Minnesota health care program requirements;
(2) regular reviews of provider qualifications, and including requests of proof of
documentation; and
(3) processes to gather the necessary information to determine provider
qualifications.
    By July 2010, Beginning July 2011, staff that provide direct contact, as defined
in section 245C.02, subdivision 11, that are employees of waiver service providers for
services specified in the federally approved waiver plans must meet the requirements
of chapter 245C prior to providing waiver services and as part of ongoing enrollment.
Beginning July 2012, service owners and managerial officials overseeing the management
or policies of services that provide direct contact as specified in the federally approved
waiver plans must meet the requirements of chapter 245C prior to reenrollment or, for new
providers, prior to initial enrollment. Upon federal approval, this requirement must also
apply to consumer-directed community supports.
    Subd. 1a. Definitions. For the purposes of this section, the following definitions
apply.
(a) "Home and community-based service providers" means approved vendors who
provide community services and long-term supports under medical assistance programs
that include waiver programs as defined in sections 256B.092, 256B.0915, and 256B.49,
and state plan home care services as defined in section 256B.0651.
(b) "Home and community-based service administrators" means counties and tribes
that, individually or collaboratively, administer home and community-based waiver
services delivery in a consistent manner under a state agency directive.
    Subd. 2. Rate-setting methodologies. The commissioner shall establish
statewide rate-setting methodologies that meet federal waiver requirements for home
and community-based waiver services for individuals with disabilities. The rate-setting
methodologies must abide by the principles of transparency and equitability across the
state. The methodologies must involve a uniform process of structuring rates for each
service and must promote quality and participant choice.
    Subd. 3. Payment rate criteria. (a) The payment structures and methodologies
under this section shall reflect the payment rate criteria in paragraphs (b) and (c).
(b) Payment rates must be based on reasonable costs that are ordinary, necessary,
and related to delivery of authorized client services.
(c) The commissioner must not reimburse:
(1) unauthorized service delivery;
(2) services provided under a receipt of a special grant;
(3) services provided under contract to a local school district;
(4) extended employment services under Minnesota Rules, parts 3300.2005 to
3300.3100, or vocational rehabilitation services provided under the federal Rehabilitation
Act, as amended, Title I, section 110, or Title VI-C, and not through use of medical
assistance or county social service funds; or
(5) services provided to a client by a licensed medical, therapeutic, or rehabilitation
practitioner or any other vendor of medical care which are billed separately on a
fee-for-service basis.
    Subd. 4. Rate exception process. The payment structures and methodologies
under this section must include procedures to seek authorization from the commissioner
for exceptions for very dependent persons with special needs to the rates in excess of the
amounts as determined utilizing individualized payment structures and methodologies
established by the commissioner under subdivision 2.
    Subd. 5. Shared service limits. The commissioner retains authority to limit the
number of people that share waiver and day services. Individualized payment structures
and methodologies established by the commissioner under subdivision 2 must reflect the
option to share services within the limits established by the commissioner.
    Subd. 6. Home and community-based service administrator roles and
responsibilities. The commissioner shall define roles and responsibilities of home and
community-based service administrators to include:
(1) certification functions to include monitoring and review of waiver home and
community-based service providers in compliance with federal requirements; and
(2) assessment of home and community-based waiver service capacity and
development to address identified service gaps.
    Subd. 7. Recommendations to the legislature. The commissioner shall consult
with existing advisory groups on rate-setting methodologies, provider qualifications, and
home and community-based service administrator roles and responsibilities to develop
and test processes, roles, and rate-setting methodologies described in this section. The
commissioner shall recommend by January 15, 2012, to the chairs of the legislative
committees with jurisdiction over health and human services policy and finance,
statutory changes that define the processes, roles, and rate-setting methodologies for
full implementation by January 1, 2013.

    Sec. 22. STREAMLINE CONSUMER-DIRECTED SERVICES.
The commissioner of human services shall prepare and provide recommendations
for streamlining administrative oversight, financial management, and payment protocols
for consumer-directed services administered through the commissioner, including
consumer-directed community supports, under Minnesota Statutes, sections 256B.49,
subdivision 16, and 256B.0916, subdivision 6a; consumer support grants, under Minnesota
Statutes, section 256.476; family support grants, under Minnesota Statutes, section 252.32;
and any other consumer directed service options identified by the commissioner. The
commissioner shall report to the legislature by January 15, 2012, with recommendations
prepared under this section.

ARTICLE 3

COMPREHENSIVE ASSESSMENT AND CASE MANAGEMENT REFORM

    Section 1. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to
read:
    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
    (b) "Activities of daily living" means grooming, dressing, bathing, transferring,
mobility, positioning, eating, and toileting.
    (c) "Level I behavior," effective January 1, 2010, means a category to determine
the home care rating and is based on the criteria found in this section. "Level I behavior"
means and is defined as physical aggression towards self, others, or destruction of property
that requires the immediate response of another person and either:
(1) has occurred within 30 days prior to the assessment; or
(2) there is objective evidence that, without intervention, it would have occurred
30 days prior to the assessment. Objective evidence includes logs of intervention kept
by the family or provider.
    (d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.
    (e) "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.
    (f) "Dependency in activities of daily living" means a person requires assistance to
begin and complete one or more of the activities of daily living.
    (g) "Extended personal care assistance service" means personal care assistance
services included in a service plan under one of the home and community-based services
waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49,
which exceed the amount, duration, and frequency of the state plan personal care
assistance services for participants who:
    (1) need assistance provided periodically during a week, but less than daily will not
be able to remain in their homes without the assistance, and other replacement services
are more expensive or are not available when personal care assistance services are to be
terminated; or
    (2) need additional personal care assistance services beyond the amount authorized
by the state plan personal care assistance assessment in order to ensure that their safety,
health, and welfare are provided for in their homes.
    (h) "Health-related procedures and tasks" means procedures and tasks that can
be delegated or assigned by a licensed health care professional under state law to be
performed by a personal care assistant.
    (i) "Instrumental activities of daily living" means activities to include meal planning
and preparation; basic assistance with paying bills; shopping for food, clothing, and other
essential items; performing household tasks integral to the personal care assistance
services; communication by telephone and other media; and traveling, including to
medical appointments and to participate in the community.
    (j) "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.
    (k) "Qualified professional" means a professional providing supervision of personal
care assistance services and staff as defined in section 256B.0625, subdivision 19c.
    (l) "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and
includes a personal care assistance provider organization, personal care assistance choice
agency, class A licensed nursing agency, and Medicare-certified home health agency.
    (m) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.
    (n) "Personal care assistance care plan" means a written description of personal
care assistance services developed by the personal care assistance provider according
to the service plan.
    (o) "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.
    (p) "Self-administered medication" means medication taken orally, by injection,
nebulizer, or insertion, or applied topically without the need for assistance.
    (q) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.
    (r) "Wages and benefits" means wages and salaries, the employer's share of FICA
taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, and contributions to employee retirement
accounts.

    Sec. 2. Minnesota Statutes 2010, section 256B.0659, subdivision 2, is amended to read:
    Subd. 2. Personal care assistance services; covered services. (a) The personal
care assistance services eligible for payment include services and supports furnished
to an individual, as needed, to assist in:
(1) activities of daily living;
(2) health-related procedures and tasks;
(3) observation and redirection of behaviors; and
(4) instrumental activities of daily living.
(b) Activities of daily living include the following covered services:
(1) dressing, including assistance with choosing, application, and changing of
clothing and application of special appliances, wraps, or clothing;
(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
except for recipients who are diabetic or have poor circulation;
(3) bathing, including assistance with basic personal hygiene and skin care;
(4) eating, including assistance with hand washing and application of orthotics
required for eating, transfers, and feeding;
(5) transfers, including assistance with transferring the recipient from one seating or
reclining area to another;
(6) mobility, including assistance with ambulation, including use of a wheelchair.
Mobility does not include providing transportation for a recipient;
(7) positioning, including assistance with positioning or turning a recipient for
necessary care and comfort; and
(8) toileting, including assistance with helping recipient with bowel or bladder
elimination and care including transfers, mobility, positioning, feminine hygiene, use of
toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and
adjusting clothing.
(c) Health-related procedures and tasks include the following covered services:
(1) range of motion and passive exercise to maintain a recipient's strength and
muscle functioning;
(2) assistance with self-administered medication as defined by this section, including.
The personal care assistant must not determine the medication dose or time for the
medication. Assistance with medications includes reminders to take medication, bringing
medication to the recipient, and assistance with opening medication under the direction of
the recipient or responsible party, including medications given through a nebulizer;
(3) interventions for seizure disorders, including monitoring and observation; and
(4) other activities considered within the scope of the personal care service and
meeting the definition of health-related procedures and tasks under this section.
(d) A personal care assistant may provide health-related procedures and tasks
associated with the complex health-related needs of a recipient if the procedures and
tasks meet the definition of health-related procedures and tasks under this section and the
personal care assistant is trained by a qualified professional and demonstrates competency
to safely complete the procedures and tasks. Delegation of health-related procedures and
tasks and all training must be documented in the personal care assistance care plan and the
recipient's and personal care assistant's files.
(e) Effective January 1, 2010, for a personal care assistant to provide the
health-related procedures and tasks of tracheostomy suctioning and services to recipients
on ventilator support there must be:
(1) delegation and training by a registered nurse, certified or licensed respiratory
therapist, or a physician;
(2) utilization of clean rather than sterile procedure;
(3) specialized training about the health-related procedures and tasks and equipment,
including ventilator operation and maintenance;
(4) individualized training regarding the needs of the recipient; and
(5) supervision by a qualified professional who is a registered nurse.
(f) Effective January 1, 2010, a personal care assistant may observe and redirect the
recipient for episodes where there is a need for redirection due to behaviors. Training of
the personal care assistant must occur based on the needs of the recipient, the personal
care assistance care plan, and any other support services provided.
(g) Instrumental activities of daily living under subdivision 1, paragraph (i).

    Sec. 3. Minnesota Statutes 2010, section 256B.0659, subdivision 3a, is amended to
read:
    Subd. 3a. Assessment; defined. This subdivision is effective until notification
is given by the commissioner as described under section 256B.0911, subdivision 3a.
"Assessment" means a review and evaluation of a recipient's need for home personal care
assistance services conducted in person. Assessments for personal care assistance services
shall be conducted by the county public health nurse or a certified public health nurse under
contract with the county except when a long-term care consultation is being conducted
for the purposes of determining a person's eligibility for home and community-based
waiver services according to section 256B.0911 and the support plan may include personal
care assistance services. An in-person assessment must include: documentation of
health status, determination of need, evaluation of service effectiveness, identification of
appropriate services, service plan development or modification, coordination of services,
referrals and follow-up to appropriate payers and community resources, completion of
required reports, recommendation of service authorization, and consumer education.
Once the need for personal care assistance services is determined under this section or
sections 256B.0651, 256B.0653, 256B.0654, and 256B.0656, the county public health
nurse or certified public health nurse under contract with the county is responsible for
communicating this recommendation to the commissioner and the recipient. An in-person
assessment must occur at least annually or when there is a significant change in the
recipient's condition or when there is a change in the need for personal care assistance
services. A service update may substitute for the annual face-to-face assessment when
there is not a significant change in recipient condition or a change in the need for
personal care assistance service. A service update may be completed by telephone, used
when there is no need for an increase in personal care assistance services, and used
for two consecutive assessments if followed by a face-to-face assessment. A service
update must be completed on a form approved by the commissioner. A service update
or review for temporary increase includes a review of initial baseline data, evaluation of
service effectiveness, redetermination of service need, modification of service plan and
appropriate referrals, update of initial forms, obtaining service authorization, and on going
consumer education. Assessments or reassessments must be completed on forms provided
by the commissioner within 30 20 days of a request for home care services by a recipient
or responsible party or personal care provider agency.

    Sec. 4. Minnesota Statutes 2010, section 256B.0659, subdivision 4, is amended to read:
    Subd. 4. Assessment for personal care assistance services; limitations. (a) An
assessment as defined in subdivision 3a must be completed for personal care assistance
services.
    (b) The following limitations apply to the assessment:
    (1) a person must be assessed as dependent in an activity of daily living based on the
person's daily need or need on the days during the week the activity is completed for:
    (i) cuing and constant supervision to complete the task; or
    (ii) hands-on assistance to complete the task; and
    (2) a child may not be found to be dependent in an activity of daily living if because
of the child's age an adult would either perform the activity for the child or assist the child
with the activity. Assistance needed is the assistance appropriate for a typical child of
the same age.
    (c) Assessment for complex health-related needs must meet the criteria in this
paragraph. During the assessment process, a recipient qualifies as having complex
health-related needs if the recipient has one or more of the interventions that are ordered by
a physician, specified in a personal care assistance care plan, and found in the following:
    (1) tube feedings requiring:
    (i) a gastrojejunostomy tube; or
    (ii) continuous tube feeding lasting longer than 12 hours per day;
    (2) wounds described as:
    (i) stage III or stage IV;
    (ii) multiple wounds;
    (iii) requiring sterile or clean dressing changes or a wound vac; or
    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
specialized care;
    (3) parenteral therapy described as:
    (i) IV therapy more than two times per week lasting longer than four hours for
each treatment; or
    (ii) total parenteral nutrition (TPN) daily;
    (4) respiratory interventions, including:
    (i) oxygen required more than eight hours per day;
    (ii) respiratory vest more than one time per day;
    (iii) bronchial drainage treatments more than two times per day;
    (iv) sterile or clean suctioning more than six times per day;
    (v) dependence on another to apply respiratory ventilation augmentation devices
such as BiPAP and CPAP; and
    (vi) ventilator dependence under section 256B.0652;
    (5) insertion and maintenance of catheter, including:
    (i) sterile catheter changes more than one time per month;
    (ii) clean intermittent catheterization, and including self-catheterization more than
six times per day; or
    (iii) bladder irrigations;
    (6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
    (7) neurological intervention, including:
    (i) seizures more than two times per week and requiring significant physical
assistance to maintain safety; or
    (ii) swallowing disorders diagnosed by a physician and requiring specialized
assistance from another on a daily basis; and
    (8) other congenital or acquired diseases creating a need for significantly increased
direct hands-on assistance and interventions in six to eight activities of daily living.
    (d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
assistance at least four times per week and shows one or more of the following behaviors:
    (1) physical aggression towards self or others, or destruction of property that requires
the immediate response of another person;
    (2) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or
    (3) increased need for assistance for recipients who are verbally aggressive and or
resistive to care such that the time needed to perform activities of daily living is increased.

    Sec. 5. Minnesota Statutes 2010, section 256B.0911, subdivision 1, is amended to read:
    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation
services is to assist persons with long-term or chronic care needs in making long-term care
decisions and selecting support and service options that meet their needs and reflect their
preferences. The availability of, and access to, information and other types of assistance,
including assessment and support planning, is also intended to prevent or delay certified
nursing facility institutional placements and to provide access to transition assistance
after admission. Further, the goal of these services is to contain costs associated with
unnecessary certified nursing facility institutional admissions. Long-term consultation
services must be available to any person regardless of public program eligibility. The
commissioner of human services shall seek to maximize use of available federal and state
funds and establish the broadest program possible within the funding available.
(b) These services must be coordinated with long-term care options counseling
provided under section 256.975, subdivision 7, and section 256.01, subdivision 24, for
telephone assistance and follow up and to offer a variety of cost-effective alternatives
to persons with disabilities and elderly persons. The county or tribal lead agency or
managed care plan providing long-term care consultation services shall encourage the use
of volunteers from families, religious organizations, social clubs, and similar civic and
service organizations to provide community-based services.

    Sec. 6. Minnesota Statutes 2010, section 256B.0911, subdivision 1a, is amended to
read:
    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
    (a) "Long-term care consultation services" means:
    (1) intake for and access to assistance in identifying services needed to maintain an
individual in the most inclusive environment;
    (2) providing recommendations on for and referrals to cost-effective community
services that are available to the individual;
    (3) development of an individual's person-centered community support plan;
    (4) providing information regarding eligibility for Minnesota health care programs;
    (5) face-to-face long-term care consultation assessments, which may be completed
in a hospital, nursing facility, intermediate care facility for persons with developmental
disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
residence;
    (6) federally mandated preadmission screening to determine the need for an
institutional level of care activities described under subdivision subdivisions 4a and 4b;
    (7) determination of home and community-based waiver and other service eligibility
as required under sections 256B.0913, 256B.0915, and 256B.49, including level of care
determination for individuals who need an institutional level of care as defined under
section 144.0724, subdivision 11, or 256B.092, service eligibility including state plan
home care services identified in sections 256B.0625, subdivisions 6, 7, and 19, paragraphs
(a) and (c), and 256B.0657, based on assessment and community support plan development
with, appropriate referrals to obtain necessary diagnostic information, and including the
option an eligibility determination for consumer-directed community supports;
(8) providing recommendations for institutional placement when there are no
cost-effective community services available; and
(9) providing access to assistance to transition people back to community settings
after institutional admission.
(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
2c, and 3a, "long-term care consultation services" also means:
(1) service eligibility determination for state plan home care services identified in:
(i) section 256B.0625, subdivisions 7, 19a, and 19c;
(ii) section 256B.0657; or
(iii) consumer support grants under section 256.476;
(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
determination of eligibility for case management services available under sections
256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part
9525.0016, and also includes obtaining necessary diagnostic information; and
(3) determination of institutional level of care, waiver, and other service eligibility
as required under section 256B.092, determination of eligibility for family support grants
under section 252.32, semi-independent living services under section 252.275, and day
training and habilitation services under section 256B.092.
    (8) providing recommendations for nursing facility placement when there are no
cost-effective community services available; and
    (9) assistance to transition people back to community settings after facility
admission.
    (b) (c) "Long-term care options counseling" means the services provided by the
linkage lines as mandated by sections 256.01 and 256.975, subdivision 7, and also
includes telephone assistance and follow up once a long-term care consultation assessment
has been completed.
    (c) (d) "Minnesota health care programs" means the medical assistance program
under chapter 256B and the alternative care program under section 256B.0913.
    (d) (e) "Lead agencies" means counties administering or a collaboration of counties,
tribes, and health plans administering under contract with the commissioner to administer
long-term care consultation assessment and support planning services.

    Sec. 7. Minnesota Statutes 2010, section 256B.0911, subdivision 2b, is amended to
read:
    Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, This section is
effective upon completion of the training and certification process identified in subdivision
2c. Each lead agency shall use certified assessors who have completed training and the
certification processes determined by the commissioner in subdivision 2c. Certified
assessors shall demonstrate best practices in assessment and support planning including
person-centered planning principals and have a common set of skills that must ensure
consistency and equitable access to services statewide. Assessors must be part of a
multidisciplinary team of professionals that includes public health nurses, social workers,
and other professionals as defined in paragraph (b). For persons with complex health care
needs, a public health nurse or registered nurse from a multidisciplinary team must be
consulted. A lead agency may choose, according to departmental policies, to contract
with a qualified, certified assessor to conduct assessments and reassessments on behalf
of the lead agency.
    (b) Certified assessors are persons with a minimum of a bachelor's degree in social
work, nursing with a public health nursing certificate, or other closely related field with at
least one year of home and community-based experience or a two-year registered nursing
degree with at least three years of home and community-based experience that have
received training and certification specific to assessment and consultation for long-term
care services in the state.

    Sec. 8. Minnesota Statutes 2010, section 256B.0911, subdivision 2c, is amended to
read:
    Subd. 2c. Assessor training and certification. The commissioner shall develop
and implement a curriculum and an assessor certification process to begin no later than
January 1, 2010. All existing lead agency staff designated to provide the services defined
in subdivision 1a must be certified by December 30, 2010. within timelines specified by
the commissioner, but no sooner than six months after statewide availability of the training
and certification process. The commissioner must establish the timelines for training and
certification in such a manner that allows lead agencies to most efficiently adopt the
automated process established in subdivision 5. Each lead agency is required to ensure
that they have sufficient numbers of certified assessors to provide long-term consultation
assessment and support planning within the timelines and parameters of the service by
January 1, 2011. Certified assessors are required to be recertified every three years.

    Sec. 9. Minnesota Statutes 2010, section 256B.0911, subdivision 3, is amended to read:
    Subd. 3. Long-term care consultation team. (a) Until January 1, 2011, A long-term
care consultation team shall be established by the county board of commissioners. Each
local consultation team shall consist of at least one social worker and at least one public
health nurse from their respective county agencies. The board may designate public
health or social services as the lead agency for long-term care consultation services. If a
county does not have a public health nurse available, it may request approval from the
commissioner to assign a county registered nurse with at least one year experience in
home care to participate on the team. Two or more counties may collaborate to establish
a joint local consultation team or teams.
(b) Certified assessors must be part of a multidisciplinary team of professionals
that includes public health nurses, social workers, and other professionals as defined in
subdivision 2b, paragraph (b). The team is responsible for providing long-term care
consultation services to all persons located in the county who request the services,
regardless of eligibility for Minnesota health care programs.
(c) The commissioner shall allow arrangements and make recommendations that
encourage counties and tribes to collaborate to establish joint local long-term care
consultation teams to ensure that long-term care consultations are done within the
timelines and parameters of the service. This includes integrated service models as
required in subdivision 1, paragraph (b).
(d) Tribes and health plans under contract with the commissioner must provide
long-term care consultation services as specified in the contract.

    Sec. 10. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to
read:
    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 15 20
calendar days after the date on which an assessment was requested or recommended.
After January 1, 2011 Upon statewide implementation of subdivisions 2b, 2c, and 5,
these requirements this requirement also apply applies to assessment of persons requesting
personal care assistance services, and private duty nursing, and home health agency
services, on timelines established in subdivision 5. The commissioner shall provide at
least a 90-day notice to lead agencies prior to the effective date of this requirement.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).
    (b) The county may utilize a team of either the social worker or public health nurse,
or both. After January 1, 2011 Upon implementation of subdivisions 2b, 2c, and 5, lead
agencies shall use certified assessors to conduct the assessment in a face-to-face interview
assessments. The consultation team members must confer regarding the most appropriate
care for each individual screened or assessed. For persons with complex health care needs,
a public health or registered nurse from the team must be consulted.
    (c) The assessment must be comprehensive and include a person-centered assessment
of the health, psychological, functional, environmental, and social needs of referred
individuals and provide information necessary to develop a community support plan that
meets the consumers needs, using an assessment form provided by the commissioner.
    (d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, as required by legally executed
documents, and other individuals as requested by the person, who can provide information
on the needs, strengths, and preferences of the person necessary to develop a community
support plan that ensures the person's health and safety, but who is not a provider of
service or has any financial interest in the provision of services.
    (e) The person, or the person's legal representative, must be provided with written
recommendations for community-based services, including consumer-directed options,
or institutional care that include documentation that the most cost-effective alternatives
available were offered to the individual. For purposes of this requirement, "cost-effective
alternatives" means community services and living arrangements that cost the same as or
less than institutional care.
    (f) (e) If the person chooses to use community-based services, the person or the
person's legal representative must be provided with a written community support plan
within 40 calendar days of the assessment visit, regardless of whether the individual
is eligible for Minnesota health care programs. The written community support plan
must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including all
available options for case management services and providers;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For persons determined eligible for services defined under subdivision 1a,
paragraphs (a), clause (7), and (b), the community support plan must also include the
estimated annual and monthly budget amount for those services. In addition, for persons
determined eligible for state plan home care under subdivision 1a, paragraph (b), clause
(1), the person or person's representative must also receive a copy of the home care service
plan developed by the certified assessor.
(f) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying
community support, the person must be transferred or referred to the long-term care
options counseling services available under sections 256.975, subdivision 7, and 256.01,
subdivision 24, for telephone assistance and follow up.
    (g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in subdivision 4a, paragraph (c).
    (h) The team lead agency must give the person receiving assessment or support
planning, or the person's legal representative, materials, and forms supplied by the
commissioner containing the following information:
    (1) written recommendations for community-based services and consumer-directed
options;
(2) documentation that the most cost-effective alternatives available were offered to
the individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For individuals
found to meet eligibility criteria for home and community-based service programs under
sections 256B.0915, 256B.092, or 256B.49, "cost effectiveness" has the meaning found
in the federally approved waiver plan for each program;
(3) the need for and purpose of preadmission screening if the person selects nursing
facility placement;
    (2) (4) the role of the long-term care consultation assessment and support planning
in waiver and alternative care program eligibility determination for waiver and alternative
care programs, and state plan home care, case management, and other services as defined
in subdivision 1a, paragraphs (a), clause (7), and (b);
    (3) (5) information about Minnesota health care programs;
    (4) (6) the person's freedom to accept or reject the recommendations of the team;
    (5) (7) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;
    (6) (8) the long-term care consultant's certified assessor's decision regarding the
person's need for institutional level of care as determined under criteria established
in section 144.0724, subdivision 11, or 256B.092 and the certified assessor's decision
regarding eligibility for all services and programs as defined in subdivision 1a, paragraphs
(a), clause (7), and (b) ; and
    (7) (9) the person's right to appeal any certified assessor's decision regarding
eligibility for all services and programs as defined in subdivision 1a, paragraph (a), clause
(7), and paragraph (b), and incorporating the decision regarding the need for nursing
facility institutional level of care or the county's lead agency's final decisions regarding
public programs eligibility according to section 256.045, subdivision 3.
    (i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and traumatic brain injury waiver programs under sections
256B.0913, 256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility
for no more than 60 calendar days after the date of assessment. The effective eligibility
start date for these programs can never be prior to the date of assessment. If an assessment
was completed more than 60 days before the effective waiver or alternative care program
eligibility start date, assessment and support plan information must be updated in a
face-to-face visit and documented in the department's Medicaid Management Information
System (MMIS). Notwithstanding retroactive medical assistance coverage of state plan
services, the effective date of program eligibility in this case for programs included in this
item cannot be prior to the date the most recent updated assessment is completed.

    Sec. 11. Minnesota Statutes 2010, section 256B.0911, subdivision 3b, is amended to
read:
    Subd. 3b. Transition assistance. (a) A long-term care consultation team Lead
agency certified assessors shall provide assistance to persons residing in a nursing
facility, hospital, regional treatment center, or intermediate care facility for persons with
developmental disabilities who request or are referred for assistance. Transition assistance
must include assessment, community support plan development, referrals to long-term
care options counseling under section 256B.975 256.975, subdivision 10 7, for community
support plan implementation and to Minnesota health care programs, including home and
community-based waiver services and consumer-directed options through the waivers,
and referrals to programs that provide assistance with housing. Transition assistance
must also include information about the Centers for Independent Living and the Senior
LinkAge Line, Disability Linkage Line, and about other organizations that can provide
assistance with relocation efforts, and information about contacting these organizations to
obtain their assistance and support.
    (b) The county lead agency shall develop transition processes with institutional
social workers and discharge planners to ensure that:
    (1) referrals for in-person assessments are taken from long-term care options
counselors as provided for in section 256.975, subdivision 7, paragraph (b), clause (11);
(2) persons admitted to facilities assessed in institutions receive information about
transition assistance that is available;
    (2) (3) the assessment is completed for persons within ten working 20 calendar days
of the date of request or recommendation for assessment; and
    (3) (4) there is a plan for transition and follow-up for the individual's return to the
community. The plan must require, including notification of other local agencies when a
person who may require assistance is screened by one county for admission to a facility
from agencies located in another county.; and
(5) relocation targeted case management as defined in section 256B.0621,
subdivision 2, clause (4), is authorized for an eligible medical assistance recipient.
    (c) If a person who is eligible for a Minnesota health care program is admitted to a
nursing facility, the nursing facility must include a consultation team member or the case
manager in the discharge planning process.

    Sec. 12. Minnesota Statutes 2010, section 256B.0911, subdivision 3c, is amended to
read:
    Subd. 3c. Transition to housing with services. (a) Housing with services
establishments offering or providing assisted living under chapter 144G shall inform
all prospective residents of the availability of and contact information for transitional
consultation services under this subdivision prior to executing a lease or contract with the
prospective resident. The purpose of transitional long-term care consultation is to support
persons with current or anticipated long-term care needs in making informed choices
among options that include the most cost-effective and least restrictive settings, and to
delay spenddown to eligibility for publicly funded programs by connecting people to
alternative services in their homes before transition to housing with services. Regardless
of the consultation, prospective residents maintain the right to choose housing with
services or assisted living if that option is their preference.
    (b) Transitional consultation services are provided as determined by the
commissioner of human services in partnership with county long-term care consultation
units, and the Area Agencies on Aging, and are a combination of telephone-based
and in-person assistance provided under models developed by the commissioner. The
consultation shall be performed in a manner that provides objective and complete
information. Transitional consultation must be provided within five working days of the
request of the prospective resident as follows:
    (1) the consultation must be provided by a qualified professional as determined by
the commissioner;
    (2) the consultation must include a review of the prospective resident's reasons for
considering assisted living, the prospective resident's personal goals, a discussion of the
prospective resident's immediate and projected long-term care needs, and alternative
community services or assisted living settings that may meet the prospective resident's
needs; and
    (3) the prospective resident shall be informed of the availability of long-term care
consultation services described in subdivision 3a that are available at no charge to the
prospective resident to assist the prospective resident in assessment and planning to meet
the prospective resident's long-term care needs. The Senior LinkAge Line and long-term
care consultation team shall give the highest priority to referrals of individuals who are at
highest risk of nursing facility placement or as needed for determining eligibility.

    Sec. 13. Minnesota Statutes 2010, section 256B.0911, subdivision 4a, is amended to
read:
    Subd. 4a. Preadmission screening activities related to nursing facility
admissions. (a) All applicants to Medicaid certified nursing facilities, including certified
boarding care facilities, must be screened prior to admission regardless of income, assets,
or funding sources for nursing facility care, except as described in subdivision 4b. The
purpose of the screening is to determine the need for nursing facility level of care as
described in paragraph (d) and to complete activities required under federal law related to
mental illness and developmental disability as outlined in paragraph (b).
(b) A person who has a diagnosis or possible diagnosis of mental illness or
developmental disability must receive a preadmission screening before admission
regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need
for further evaluation and specialized services, unless the admission prior to screening is
authorized by the local mental health authority or the local developmental disabilities case
manager, or unless authorized by the county agency according to Public Law 101-508.
The following criteria apply to the preadmission screening:
(1) the county lead agency must use forms and criteria developed by the
commissioner to identify persons who require referral for further evaluation and
determination of the need for specialized services; and
(2) the evaluation and determination of the need for specialized services must be
done by:
(i) a qualified independent mental health professional, for persons with a primary or
secondary diagnosis of a serious mental illness; or
(ii) a qualified developmental disability professional, for persons with a primary or
secondary diagnosis of developmental disability. For purposes of this requirement, a
qualified developmental disability professional must meet the standards for a qualified
developmental disability professional under Code of Federal Regulations, title 42, section
483.430 .
(c) The local county mental health authority or the state developmental disability
authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
nursing facility if the individual does not meet the nursing facility level of care criteria or
needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
purposes of this section, "specialized services" for a person with developmental disability
means active treatment as that term is defined under Code of Federal Regulations, title
42, section 483.440 (a)(1).
(d) The determination of the need for nursing facility level of care must be made
according to criteria established in section 144.0724, subdivision 11, and 256B.092,
using forms developed by the commissioner. In assessing a person's needs, consultation
team members shall have a physician available for consultation and shall consider the
assessment of the individual's attending physician, if any. The individual's physician must
be included if the physician chooses to participate. Other personnel may be included on
the team as deemed appropriate by the county lead agency.

    Sec. 14. Minnesota Statutes 2010, section 256B.0911, subdivision 4c, is amended to
read:
    Subd. 4c. Screening requirements. (a) A person may be screened for nursing
facility admission by telephone or in a face-to-face screening interview. Consultation team
members Certified assessors shall identify each individual's needs using the following
categories:
    (1) the person needs no face-to-face screening interview to determine the need
for nursing facility level of care based on information obtained from other health care
professionals;
    (2) the person needs an immediate face-to-face screening interview to determine the
need for nursing facility level of care and complete activities required under subdivision
4a; or
    (3) the person may be exempt from screening requirements as outlined in subdivision
4b, but will need transitional assistance after admission or in-person follow-along after
a return home.
    (b) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
facility must be screened prior to admission.
    (c) The county lead agency screening or intake activity must include processes to
identify persons who may require transition assistance as described in subdivision 3b.

    Sec. 15. Minnesota Statutes 2010, section 256B.0911, subdivision 6, is amended to
read:
    Subd. 6. Payment for long-term care consultation services. (a) The total payment
for each county must be paid monthly by certified nursing facilities in the county. The
monthly amount to be paid by each nursing facility for each fiscal year must be determined
by dividing the county's annual allocation for long-term care consultation services by 12
to determine the monthly payment and allocating the monthly payment to each nursing
facility based on the number of licensed beds in the nursing facility. Payments to counties
in which there is no certified nursing facility must be made by increasing the payment
rate of the two facilities located nearest to the county seat.
    (b) The commissioner shall include the total annual payment determined under
paragraph (a) for each nursing facility reimbursed under section 256B.431 or, 256B.434
according to section 256B.431, subdivision 2b, paragraph (g), or 256B.441.
    (c) In the event of the layaway, delicensure and decertification, or removal from
layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
the per diem payment amount in paragraph (b) and may adjust the monthly payment
amount in paragraph (a). The effective date of an adjustment made under this paragraph
shall be on or after the first day of the month following the effective date of the layaway,
delicensure and decertification, or removal from layaway.
    (d) Payments for long-term care consultation services are available to the county
or counties to cover staff salaries and expenses to provide the services described in
subdivision 1a. The county shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provide long-term care consultation
services while meeting the state's long-term care outcomes and objectives as defined in
section 256B.0917, subdivision 1. The county shall be accountable for meeting local
objectives as approved by the commissioner in the biennial home and community-based
services quality assurance plan on a form provided by the commissioner.
    (e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.
    (f) The commissioner of human services shall amend the Minnesota medical
assistance plan to include reimbursement for the local consultation teams.
    (g) Until the alternative payment methodology in paragraph (h) is implemented,
the county may bill, as case management services, assessments, support planning, and
follow-along provided to persons determined to be eligible for case management under
Minnesota health care programs. No individual or family member shall be charged for an
initial assessment or initial support plan development provided under subdivision 3a or 3b.
(h) The commissioner shall develop an alternative payment methodology for
long-term care consultation services that includes the funding available under this
subdivision, and sections 256B.092 and 256B.0659. In developing the new payment
methodology, the commissioner shall consider the maximization of other funding sources,
including federal funding, for this all long-term care consultation and preadmission
screening activity.

    Sec. 16. Minnesota Statutes 2010, section 256B.0913, subdivision 7, is amended to
read:
    Subd. 7. Case management. (a) The provision of case management under the
alternative care program is governed by requirements in section 256B.0915, subdivisions
1a and 1b.
(b) The case manager must not approve alternative care funding for a client in any
setting in which the case manager cannot reasonably ensure the client's health and safety.
(c) The case manager is responsible for the cost-effectiveness of the alternative care
individual care coordinated services and support plan and must not approve any care plan
in which the cost of services funded by alternative care and client contributions exceeds
the limit specified in section 256B.0915, subdivision 3, paragraph (b).
(d) Case manager responsibilities include those in section 256B.0915, subdivision
1a, paragraph (g).

    Sec. 17. Minnesota Statutes 2010, section 256B.0913, subdivision 8, is amended to
read:
    Subd. 8. Requirements for individual care coordinated services and support
plan. (a) The case manager shall implement the coordinated services and support plan of
care for each alternative care client and ensure that a client's service needs and eligibility
are reassessed at least every 12 months. The coordinated services and support plan must
meet the requirements in section 256B.0915, subdivision 6. The plan shall include any
services prescribed by the individual's attending physician as necessary to allow the
individual to remain in a community setting. In developing the individual's care plan, the
case manager should include the use of volunteers from families and neighbors, religious
organizations, social clubs, and civic and service organizations to support the formal home
care services. The lead agency shall be held harmless for damages or injuries sustained
through the use of volunteers under this subdivision including workers' compensation
liability. The case manager shall provide documentation in each individual's plan of care
and, if requested, to the commissioner that the most cost-effective alternatives available
have been offered to the individual and that the individual was free to choose among
available qualified providers, both public and private, including qualified case management
or service coordination providers other than those employed by any county; however, the
county or tribe maintains responsibility for prior authorizing services in accordance with
statutory and administrative requirements. The case manager must give the individual a
ten-day written notice of any denial, termination, or reduction of alternative care services.
    (b) The county of service or tribe must provide access to and arrange for case
management services, including assuring implementation of the coordinated services
and support plan. "County of service" has the meaning given it in Minnesota Rules,
part 9505.0015, subpart 11. The county of service must notify the county of financial
responsibility of the approved care plan and the amount of encumbered funds.

    Sec. 18. Minnesota Statutes 2010, section 256B.0915, subdivision 1a, is amended to
read:
    Subd. 1a. Elderly waiver case management services. (a) Elderly Except
as provided to individuals under prepaid medical assistance programs as described
in paragraph (h), case management services under the home and community-based
services waiver for elderly individuals are available from providers meeting qualification
requirements and the standards specified in subdivision 1b. Eligible recipients may choose
any qualified provider of elderly case management services.
    (b) Case management services assist individuals who receive waiver services in
gaining access to needed waiver and other state plan services, and assist individuals in
appeals under section 256.045, as well as needed medical, social, educational, and other
services regardless of the funding source for the services to which access is gained. Case
managers shall collaborate with consumers, families, legal representatives, and relevant
medical experts and service providers in the development and periodic review of the
coordinated services and support plan.
    (c) A case aide shall provide assistance to the case manager in carrying out
administrative activities of the case management function. The case aide may not assume
responsibilities that require professional judgment including assessments, reassessments,
and care plan development. The case manager is responsible for providing oversight of
the case aide.
    (d) Case managers shall be responsible for ongoing monitoring of the provision of
services included in the individual's plan of care. Case managers shall initiate and oversee
the process of assessment and reassessment of the individual's care coordinated services
and support plan as defined in subdivision 6 and review the plan of care at intervals
specified in the federally approved waiver plan.
    (e) The county of service or tribe must provide access to and arrange for case
management services. County of service has the meaning given it in Minnesota Rules,
part 9505.0015, subpart 11.
(f) Except as described in paragraph (h), case management services must be provided
by a public or private agency that is enrolled as a medical assistance provider determined
by the commissioner to meet all of the requirements in subdivision 1b. Case management
services must not be provided to a recipient by a private agency that has a financial interest
in the provision of any other services included in the recipient's coordinated service and
support plan. For purposes of this section, "private agency" means any agency that is not
identified as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).
(g) Case management service activities provided to or arranged for a person include:
(1) development of the coordinated services and support plan under subdivision 6;
(2) informing the individual or the individual's legal guardian or conservator of
service options, and options for case management services and providers;
(3) consulting with relevant medical experts or service providers;
(4) assisting the person in the identification of potential providers;
(5) assisting the person to access services;
(6) coordination of services; and
(7) evaluation and monitoring of the services identified in the plan, including at least
one annual face-to-face visit by the case manager with each person.
(h) For individuals enrolled in prepaid medical assistance programs under section
256B.69, subdivisions 6b and 23, the health plan shall provide or arrange to provide
elderly waiver case management services in paragraph (g), as part of an integrated delivery
system in accordance with contract requirements established by the commissioner.

    Sec. 19. Minnesota Statutes 2010, section 256B.0915, subdivision 1b, is amended to
read:
    Subd. 1b. Provider qualifications and standards. (a) The commissioner must
enroll qualified providers of elderly case management services under the home and
community-based waiver for the elderly under section 1915(c) of the Social Security
Act. The enrollment process shall ensure the provider's ability to meet the qualification
requirements and standards in this subdivision and other federal and state requirements
of this service. An elderly A case management provider is an enrolled medical
assistance provider who is determined by the commissioner to have all of the following
characteristics:
    (1) the demonstrated capacity and experience to provide the components of
case management to coordinate and link community resources needed by the eligible
population;
    (2) administrative capacity and experience in serving the target population for
whom it will provide services and in ensuring quality of services under state and federal
requirements;
    (3) a financial management system that provides accurate documentation of services
and costs under state and federal requirements;
    (4) the capacity to document and maintain individual case records under state and
federal requirements; and
    (5) the lead agency may allow a case manager employed by the lead agency to
delegate certain aspects of the case management activity to another individual employed
by the lead agency provided there is oversight of the individual by the case manager.
The case manager may not delegate those aspects which require professional judgment
including assessments, reassessments, and care coordinated services and support plan
development. Lead agencies include counties, health plans, and federally recognized
tribes who authorize services under this section.
(b) A health plan shall provide or arrange to provide elderly waiver case
management services in subdivision 1a, paragraph (g), as part of an integrated delivery
system in accordance with contract requirements established by the commissioner related
to provider standards and qualifications.

    Sec. 20. Minnesota Statutes 2010, section 256B.0915, subdivision 3c, is amended to
read:
    Subd. 3c. Service approval and contracting provisions. (a) Medical assistance
funding for skilled nursing services, private duty nursing, home health aide, and personal
care services for waiver recipients must be approved by the case manager and included in
the individual care coordinated services and support plan.
    (b) A lead agency is not required to contract with a provider of supplies and
equipment if the monthly cost of the supplies and equipment is less than $250.

    Sec. 21. Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to
read:
    Subd. 6. Implementation of care coordinated services and support plan. (a)
Each elderly waiver client shall be provided a copy of a written care coordinated services
and support plan that meets the requirements outlined in section 256B.0913, subdivision 8.
The care plan must be implemented by the county of service when it is different than the
county of financial responsibility. The county of service administering waivered services
must notify the county of financial responsibility of the approved care plan. that:
(1) is developed and signed by the recipient within ten working days after the case
manager receives the community support plan from the certified assessor;
(2) includes the results of the assessment information on the person's need for
service and identification of service needs that will be or that are met by the person's
relatives, friends, and others, as well as community services used by the general public;
(3) reasonably ensures the health and safety of the recipient;
(4) identifies the person's preferences for services as stated by the person or the
person's legal guardian or conservator;
(5) reflects the person's informed choice between institutional and community-based
services, as well as choice of services, supports, and providers, including available case
manager providers;
(6) identifies long and short-range goals for the person;
(7) identifies specific services and the amount, frequency, duration, and cost of the
services to be provided to the person based on assessed needs, preferences, and available
resources; and
(8) includes information about the right to appeal decisions under section 256.045;
(b) In developing the coordinated services and support plan, the case manager should
also include the use of volunteers, religious organizations, social clubs, and civic and
service organizations to support the individual in the community. The lead agency must be
held harmless for damages or injuries sustained through the use of volunteers and agencies
under this paragraph, including workers' compensation liability.

    Sec. 22. Minnesota Statutes 2010, section 256B.0915, subdivision 10, is amended to
read:
    Subd. 10. Waiver payment rates; managed care organizations. The
commissioner shall adjust the elderly waiver capitation payment rates for managed
care organizations paid under section 256B.69, subdivisions 6a 6b and 23, to reflect the
maximum service rate limits for customized living services and 24-hour customized
living services under subdivisions 3e and 3h for the contract period beginning October
1, 2009. Medical assistance rates paid to customized living providers by managed
care organizations under this section shall not exceed the maximum service rate limits
determined by the commissioner under subdivisions 3e and 3h.

    Sec. 23. Minnesota Statutes 2010, section 256B.092, subdivision 1, is amended to read:
    Subdivision 1. County of financial responsibility; duties. Before any services
shall be rendered to persons with developmental disabilities who are in need of social
service and medical assistance, the county of financial responsibility shall conduct or
arrange for a diagnostic evaluation in order to determine whether the person has or may
have a developmental disability or has or may have a related condition. If the county
of financial responsibility determines that the person has a developmental disability,
the county shall inform the person of case management services available under this
section. Except as provided in subdivision 1g or 4b, if a person is diagnosed as having a
developmental disability, the county of financial responsibility shall conduct or arrange for
a needs assessment by a certified assessor, and develop or arrange for an individual service
a community support plan according to section 256B.0911, provide or arrange for ongoing
case management services at the level identified in the individual service plan, provide
or arrange for case management administration, and authorize services identified in the
person's individual service coordinated services and support plan developed according to
subdivision 1b. Diagnostic information, obtained by other providers or agencies, may be
used by the county agency in determining eligibility for case management. Nothing in this
section shall be construed as requiring: (1) assessment in areas agreed to as unnecessary
by the case manager a certified assessor and the person, or the person's legal guardian or
conservator, or the parent if the person is a minor, or (2) assessments in areas where there
has been a functional assessment completed in the previous 12 months for which the
case manager certified assessor and the person or person's guardian or conservator, or the
parent if the person is a minor, agree that further assessment is not necessary. For persons
under state guardianship, the case manager certified assessor shall seek authorization from
the public guardianship office for waiving any assessment requirements. Assessments
related to health, safety, and protection of the person for the purpose of identifying service
type, amount, and frequency or assessments required to authorize services may not be
waived. To the extent possible, for wards of the commissioner the county shall consider
the opinions of the parent of the person with a developmental disability when developing
the person's individual service community support plan and coordinated services and
support plan.

    Sec. 24. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to
read:
    Subd. 1a. Case management administration and services. (a) The administrative
functions of case management provided to or arranged for a person include: Each recipient
of a home and community-based waiver shall be provided case management services by
qualified vendors as described in the federally approved waiver application.
(1) review of eligibility for services;
(2) screening;
(3) intake;
(4) diagnosis;
(5) the review and authorization of services based upon an individualized service
plan; and
(6) responding to requests for conciliation conferences and appeals according to
section 256.045 made by the person, the person's legal guardian or conservator, or the
parent if the person is a minor.
(b) Case management service activities provided to or arranged for a person include:
(1) development of the individual service coordinated services and support plan
under subdivision 1b;
(2) informing the individual or the individual's legal guardian or conservator, or
parent if the person is a minor, of service options;
(3) consulting with relevant medical experts or service providers;
(4) assisting the person in the identification of potential providers;
(5) assisting the person to access services and assisting in appeals under section
256.045;
(6) coordination of services, if coordination is not provided by another service
provider;
(7) evaluation and monitoring of the services identified in the coordinated services
and support plan, which must incorporate at least one annual face-to-face visit by the case
manager with each person; and
(8) annual reviews of service plans and services provided review and provide the
lead agency with recommendations for service authorization based upon the individual's
needs identified in the coordinated services and support plan.
(c) Case management administration and service activities that are provided to the
person with a developmental disability shall be provided directly by county agencies or
under contract. Case management services must be provided by a public or private agency
that is enrolled as a medical assistance provider determined by the commissioner to meet
all of the requirements in the approved federal waiver plans. Case management services
must not be provided to a recipient by a private agency that has a financial interest in the
provision of any other services included in the recipient's coordinated services and support
plan. For purposes of this section, "private agency" means any agency that is not identified
as a lead agency under section 256B.0911, subdivision 1a, paragraph (d).
(d) Case managers are responsible for the administrative duties and service
provisions listed in paragraphs (a) and (b). Case managers shall collaborate with
consumers, families, legal representatives, and relevant medical experts and service
providers in the development and annual review of the individualized service coordinated
services and support plan and habilitation plans plan.
(e) The Department of Human Services shall offer ongoing education in case
management to case managers. Case managers shall receive no less than ten hours of case
management education and disability-related training each year.

    Sec. 25. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to
read:
    Subd. 1b. Individual Coordinated service and support plan. The individual
service plan must (a) Each recipient of home and community-based waivered services
shall be provided a copy of the written coordinated service and support plan which:
(1) is developed and signed by the recipient within ten working days after the case
manager receives the community support plan from the certified assessor;
(1) include (2) includes the results of the assessment information on the person's
need for service, including identification of service needs that will be or that are met
by the person's relatives, friends, and others, as well as community services used by
the general public;
(3) reasonably ensures the health and safety of the recipient;
(2) identify (4) identifies the person's preferences for services as stated by the person,
the person's legal guardian or conservator, or the parent if the person is a minor;
(5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
paragraph (o), of service and support providers, and identifies all available options for
case management services and providers;
(3) identify (6) identifies long- and short-range goals for the person;
(4) identify (7) identifies specific services and the amount and frequency of the
services to be provided to the person based on assessed needs, preferences, and available
resources. The individual service coordinated service and support plan shall also specify
other services the person needs that are not available;
(5) identify (8) identifies the need for an individual program plan to be developed
by the provider according to the respective state and federal licensing and certification
standards, and additional assessments to be completed or arranged by the provider after
service initiation;
(6) identify (9) identifies provider responsibilities to implement and make
recommendations for modification to the individual service coordinated service and
support plan;
(7) include (10) includes notice of the right to request a conciliation conference or a
hearing under section 256.045;
(8) be (11) is agreed upon and signed by the person, the person's legal guardian
or conservator, or the parent if the person is a minor, and the authorized county
representative; and
(9) be (12) is reviewed by a health professional if the person has overriding medical
needs that impact the delivery of services.
Service planning formats developed for interagency planning such as transition,
vocational, and individual family service plans may be substituted for service planning
formats developed by county agencies.
(b) In developing the coordinated services and support plan, the case manager is
encouraged to include the use of volunteers, religious organizations, social clubs, and civic
and service organizations to support the individual in the community. The lead agency
must be held harmless for damages or injuries sustained through the use of volunteers and
agencies under this paragraph, including workers' compensation liability.

    Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to
read:
    Subd. 1e. Coordination, evaluation, and monitoring of services. (a) If the
individual service coordinated service and support plan identifies the need for individual
program plans for authorized services, the case manager shall assure that individual
program plans are developed by the providers according to clauses (2) to (5). The
providers shall assure that the individual program plans:
(1) are developed according to the respective state and federal licensing and
certification requirements;
(2) are designed to achieve the goals of the individual service coordinated service
and support plan;
(3) are consistent with other aspects of the individual service coordinated service
and support plan;
(4) assure the health and safety of the person; and
(5) are developed with consistent and coordinated approaches to services among the
various service providers.
(b) The case manager shall monitor the provision of services:
(1) to assure that the individual service coordinated service and support plan is
being followed according to paragraph (a);
(2) to identify any changes or modifications that might be needed in the individual
service coordinated service and support plan, including changes resulting from
recommendations of current service providers;
(3) to determine if the person's legal rights are protected, and if not, notify the
person's legal guardian or conservator, or the parent if the person is a minor, protection
services, or licensing agencies as appropriate; and
(4) to determine if the person, the person's legal guardian or conservator, or the
parent if the person is a minor, is satisfied with the services provided.
(c) If the provider fails to develop or carry out the individual program plan according
to paragraph (a), the case manager shall notify the person's legal guardian or conservator,
or the parent if the person is a minor, the provider, the respective licensing and certification
agencies, and the county board where the services are being provided. In addition, the
case manager shall identify other steps needed to assure the person receives the services
identified in the individual service coordinated service and support plan.

    Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to
read:
    Subd. 1g. Conditions not requiring development of individual service
coordinated service and support plan. Unless otherwise required by federal law, the
county agency is not required to complete an individual service a coordinated service and
support plan as defined in subdivision 1b for:
(1) persons whose families are requesting respite care for their family member who
resides with them, or whose families are requesting a family support grant and are not
requesting purchase or arrangement of habilitative services; and
(2) persons with developmental disabilities, living independently without authorized
services or receiving funding for services at a rehabilitation facility as defined in section
268A.01, subdivision 6 , and not in need of or requesting additional services.

    Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 2, is amended to read:
    Subd. 2. Medical assistance. To assure quality case management to those persons
who are eligible for medical assistance, the commissioner shall, upon request:
(1) provide consultation on the case management process;
(2) assist county agencies in the screening and annual reviews of clients review
process to assure that appropriate levels of service are provided to persons;
(3) provide consultation on service planning and development of services with
appropriate options;
(4) provide training and technical assistance to county case managers; and
(5) authorize payment for medical assistance services according to this chapter
and rules implementing it.

    Sec. 29. Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:
    Subd. 3. Authorization and termination of services. County agency case
managers, under rules of the commissioner, shall authorize and terminate services of
community and regional treatment center providers according to individual service
support plans. Services provided to persons with developmental disabilities may only be
authorized and terminated by case managers or certified assessors according to (1) rules of
the commissioner and (2) the individual service support plan as defined in subdivision
1b and section 256B.0911. Medical assistance services not needed shall not be authorized
by county agencies or funded by the commissioner. When purchasing or arranging for
unlicensed respite care services for persons with overriding health needs, the county
agency shall seek the advice of a health care professional in assessing provider staff
training needs and skills necessary to meet the medical needs of the person.

    Sec. 30. Minnesota Statutes 2010, section 256B.092, subdivision 5, is amended to read:
    Subd. 5. Federal waivers. (a) The commissioner shall apply for any federal
waivers necessary to secure, to the extent allowed by law, federal financial participation
under United States Code, title 42, sections 1396 et seq., as amended, for the provision
of services to persons who, in the absence of the services, would need the level of care
provided in a regional treatment center or a community intermediate care facility for
persons with developmental disabilities. The commissioner may seek amendments to the
waivers or apply for additional waivers under United States Code, title 42, sections 1396
et seq., as amended, to contain costs. The commissioner shall ensure that payment for
the cost of providing home and community-based alternative services under the federal
waiver plan shall not exceed the cost of intermediate care services including day training
and habilitation services that would have been provided without the waivered services.
The commissioner shall seek an amendment to the 1915c home and
community-based waiver to allow properly licensed adult foster care homes to provide
residential services to up to five individuals with developmental disabilities. If the
amendment to the waiver is approved, adult foster care providers that can accommodate
five individuals shall increase their capacity to five beds, provided the providers continue
to meet all applicable licensing requirements.
(b) The commissioner, in administering home and community-based waivers for
persons with developmental disabilities, shall ensure that day services for eligible persons
are not provided by the person's residential service provider, unless the person or the
person's legal representative is offered a choice of providers and agrees in writing to
provision of day services by the residential service provider. The individual service
coordinated service and support plan for individuals who choose to have their residential
service provider provide their day services must describe how health, safety, protection,
and habilitation needs will be met, including how frequent and regular contact with
persons other than the residential service provider will occur. The individualized service
coordinated service and support plan must address the provision of services during the
day outside the residence on weekdays.
(c) When a county lead agency is evaluating denials, reductions, or terminations
of home and community-based services under section 256B.0916 for an individual, the
case manager lead agency shall offer to meet with the individual or the individual's
guardian in order to discuss the prioritization of service needs within the individualized
service coordinated service and support plan. The reduction in the authorized services
for an individual due to changes in funding for waivered services may not exceed the
amount needed to ensure medically necessary services to meet the individual's health,
safety, and welfare.

    Sec. 31. Minnesota Statutes 2010, section 256B.092, subdivision 7, is amended to read:
    Subd. 7. Screening teams Assessments. (a) Assessments and reassessments shall
be conducted by certified assessors according to section 256B.0911, and must incorporate
appropriate referrals to determine eligibility for case management under subdivision 1a.
(b) For persons with developmental disabilities, screening teams shall be established
which a certified assessor shall evaluate the need for the level of care provided by
residential-based habilitation services, residential services, training and habilitation
services, and nursing facility services. The evaluation assessment shall address whether
home and community-based services are appropriate for persons who are at risk of
placement in an intermediate care facility for persons with developmental disabilities, or
for whom there is reasonable indication that they might require this level of care. The
screening team certified assessor shall make an evaluation of need within 60 working
days of a request for service by a person with a developmental disability, and within
five working days of an emergency admission of a person to an intermediate care
facility for persons with developmental disabilities. The screening team shall consist of
the case manager for persons with developmental disabilities, the person, the person's
legal guardian or conservator, or the parent if the person is a minor, and a qualified
developmental disability professional, as defined in the Code of Federal Regulations,
title 42, section 483.430, as amended through June 3, 1988. The case manager may also
act as the qualified developmental disability professional if the case manager meets
the federal definition. County social service agencies may contract with a public or
private agency or individual who is not a service provider for the person for the public
guardianship representation required by the screening or individual service planning
process. The contract shall be limited to public guardianship representation for the
screening and individual service planning activities. The contract shall require compliance
with the commissioner's instructions and may be for paid or voluntary services. For
persons determined to have overriding health care needs and are seeking admission to a
nursing facility or an ICF/MR, or seeking access to home and community-based waivered
services, a registered nurse must be designated as either the case manager or the qualified
developmental disability professional. For persons under the jurisdiction of a correctional
agency, the case manager must consult with the corrections administrator regarding
additional health, safety, and supervision needs. The case manager, with the concurrence
of the person, the person's legal guardian or conservator, or the parent if the person is a
minor, may invite other individuals to attend meetings of the screening team. No member
of the screening team shall have any direct or indirect service provider interest in the case.
Nothing in this section shall be construed as requiring the screening team meeting to be
separate from the service planning meeting.

    Sec. 32. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:
    Subd. 8. Screening team Additional certified assessor duties. In addition to the
responsibilities of certified assessors described in section 256B.0911, for persons with
developmental disabilities, the screening team certified assessor shall:
(1) review diagnostic data;
(2) review health, social, and developmental assessment data using a uniform
screening tool specified by the commissioner;
(3) identify the level of services appropriate to maintain the person in the most
normal and least restrictive setting that is consistent with the person's treatment needs;
(4) (1) identify other noninstitutional public assistance or social service that may
prevent or delay long-term residential placement;
(5) (2) assess whether a person is in need of long-term residential care;
(6) (3) make recommendations regarding placement and payment for: (i) social
service or public assistance support, or both, to maintain a person in the person's own home
or other place of residence; (ii) training and habilitation service, vocational rehabilitation,
and employment training activities; (iii) community residential placement; (iv) regional
treatment center placement; or (v) a home and community-based service alternative to
community residential placement or regional treatment center placement;
(7) (4) evaluate the availability, location, and quality of the services listed in clause
(6) (3), including the impact of placement alternatives on the person's ability to maintain
or improve existing patterns of contact and involvement with parents and other family
members;
(8) (5) identify the cost implications of recommendations in clause (6) (3); and
(9) (6) make recommendations to a court as may be needed to assist the court in
making decisions regarding commitment of persons with developmental disabilities; and
(10) inform the person and the person's legal guardian or conservator, or the parent if
the person is a minor, that appeal may be made to the commissioner pursuant to section
256.045.

    Sec. 33. Minnesota Statutes 2010, section 256B.092, subdivision 8a, is amended to
read:
    Subd. 8a. County concurrence notification. (a) If the county of financial
responsibility wishes to place a person in another county for services, the county of
financial responsibility shall seek concurrence from notify the proposed county of service
and the placement shall be made cooperatively between the two counties. Arrangements
shall be made between the two counties for ongoing social service, including annual
reviews of the person's individual service coordinated service and support plan. The county
where services are provided may not make changes in the person's service coordinated
service and support plan without approval by the county of financial responsibility.
(b) When a person has been screened and authorized for services in an intermediate
care facility for persons with developmental disabilities or for home and community-based
services for persons with developmental disabilities, the case manager shall assist that
person in identifying a service provider who is able to meet the needs of the person
according to the person's individual service plan. If the identified service is to be provided
in a county other than the county of financial responsibility, the county of financial
responsibility shall request concurrence of the county where the person is requesting to
receive the identified services. The county of service may refuse to concur shall notify
the county of financial responsibility if:
(1) it can demonstrate that the provider is unable to provide the services identified in
the person's individual service plan as services that are needed and are to be provided; or
(2), in the case of an intermediate care facility for persons with developmental
disabilities, there has been no authorization for admission by the admission review team
as required in section 256B.0926.
(c) The county of service shall notify the county of financial responsibility of
concurrence or refusal to concur any concerns about the chosen provider's capacity to
meet the needs of the person seeking to move to residential services in another county no
later than 20 working days following receipt of the written request notification. Unless
other mutually acceptable arrangements are made by the involved county agencies, the
county of financial responsibility is responsible for costs of social services and the costs
associated with the development and maintenance of the placement. The county of
service may request that the county of financial responsibility purchase case management
services from the county of service or from a contracted provider of case management
when the county of financial responsibility is not providing case management as defined
in this section and rules adopted under this section, unless other mutually acceptable
arrangements are made by the involved county agencies. Standards for payment limits
under this section may be established by the commissioner. Financial disputes between
counties shall be resolved as provided in section 256G.09. This subdivision also applies to
home and community-based waiver services provided under section 256B.49.

    Sec. 34. Minnesota Statutes 2010, section 256B.092, subdivision 9, is amended to read:
    Subd. 9. Reimbursement. Payment for services shall not be provided to a
service provider for any person placed in an intermediate care facility for persons with
developmental disabilities prior to the person being screened by the screening team
receiving an assessment by a certified assessor. The commissioner shall not deny
reimbursement for: (1) a person admitted to an intermediate care facility for persons
with developmental disabilities who is assessed to need long-term supportive services,
if long-term supportive services other than intermediate care are not available in that
community; (2) any person admitted to an intermediate care facility for persons with
developmental disabilities under emergency circumstances; (3) any eligible person placed
in the intermediate care facility for persons with developmental disabilities pending an
appeal of the screening team's certified assessor's decision; or (4) any medical assistance
recipient when, after full discussion of all appropriate alternatives including those that
are expected to be less costly than intermediate care for persons with developmental
disabilities, the person or the person's legal guardian or conservator, or the parent if the
person is a minor, insists on intermediate care placement. The screening team certified
assessor shall provide documentation that the most cost-effective alternatives available
were offered to this individual or the individual's legal guardian or conservator.

    Sec. 35. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to
read:
    Subd. 11. Residential support services. (a) Upon federal approval, there is
established a new service called residential support that is available on the community
alternative care, community alternatives for disabled individuals, developmental
disabilities, and traumatic brain injury waivers. Existing waiver service descriptions
must be modified to the extent necessary to ensure there is no duplication between
other services. Residential support services must be provided by vendors licensed as a
community residential setting as defined in section 245A.11, subdivision 8.
(b) Residential support services must meet the following criteria:
(1) providers of residential support services must own or control the residential site;
(2) the residential site must not be the primary residence of the license holder;
(3) the residential site must have a designated program supervisor responsible for
program oversight, development, and implementation of policies and procedures;
(4) the provider of residential support services must provide supervision, training,
and assistance as described in the person's community coordinated services and support
plan; and
(5) the provider of residential support services must meet the requirements of
licensure and additional requirements of the person's community coordinated services and
support plan.
(c) Providers of residential support services that meet the definition in paragraph
(a) must be registered using a process determined by the commissioner beginning July
1, 2009.

    Sec. 36. Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:
    Subd. 13. Case management. (a) Each recipient of a home and community-based
waiver shall be provided case management services by qualified vendors as described
in the federally approved waiver application. The case management service activities
provided will must include:
    (1) assessing the needs of the individual within 20 working days of a recipient's
request;
    (2) developing finalizing the written individual service coordinated service and
support plan within ten working days after the assessment is completed case manager
receives the plan from the certified assessor;
    (3) informing the recipient or the recipient's legal guardian or conservator of service
options;
    (4) assisting the recipient in the identification of potential service providers and
available options for case management service and providers;
    (5) assisting the recipient to access services and assisting with appeals under section
256.045; and
    (6) coordinating, evaluating, and monitoring of the services identified in the service
plan;.
    (7) completing the annual reviews of the service plan; and
    (8) informing the recipient or legal representative of the right to have assessments
completed and service plans developed within specified time periods, and to appeal county
action or inaction under section 256.045, subdivision 3, including the determination of
nursing facility level of care.
    (b) The case manager may delegate certain aspects of the case management service
activities to another individual provided there is oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment including
assessments, reassessments, and care plan development.:
(1) finalizing the coordinated service and support plan;
(2) ongoing assessment and monitoring of the person's needs and adequacy of the
approved coordinated service and support plan; and
(3) adjustments to the coordinated service and support plan.
(c) Case management services must be provided by a public or private agency that
is enrolled as a medical assistance provider determined by the commissioner to meet all
of the requirements in the approved federal waiver plans. Case management services
must not be provided to a recipient by a private agency that has any financial interest in
the provision of any other services included in the recipient's coordinated services and
support plan. For purposes of this section, "private agency" means any agency that is not
identified as a lead agency under section 256B.0911, subdivision 1a, paragraph (d).

    Sec. 37. Minnesota Statutes 2010, section 256B.49, subdivision 14, is amended to read:
    Subd. 14. Assessment and reassessment. (a) Assessments of each recipient's
strengths, informal support systems, and need for services shall be completed within
20 working days of the recipient's request. Reassessment of each recipient's strengths,
support systems, and need for services shall be conducted at least every 12 months and at
other times when there has been a significant change in the recipient's functioning and
reassessments shall be conducted by certified assessors according to section 256B.0911,
subdivision 2b.
(b) There must be a determination that the client requires a hospital level of care or a
nursing facility level of care as defined in section 144.0724, subdivision 11, at initial and
subsequent assessments to initiate and maintain participation in the waiver program.
(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
appropriate to determine nursing facility level of care for purposes of medical assistance
payment for nursing facility services, only face-to-face assessments conducted according
to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
determination or a nursing facility level of care determination must be accepted for
purposes of initial and ongoing access to waiver services payment.
(d) Persons with developmental disabilities who apply for services under the nursing
facility level waiver programs shall be screened for the appropriate level of care according
to section 256B.092.
(e) (d) Recipients who are found eligible for home and community-based services
under this section before their 65th birthday may remain eligible for these services after
their 65th birthday if they continue to meet all other eligibility factors.

    Sec. 38. Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:
    Subd. 15. Individualized Coordinated service and support plan. (a) Each
recipient of home and community-based waivered services shall be provided a copy of the
written service coordinated service and support plan which:
(1) is developed and signed by the recipient within ten working days of the
completion of the assessment;
(2) meets the assessed needs of the recipient;
(3) reasonably ensures the health and safety of the recipient;
(4) promotes independence;
(5) allows for services to be provided in the most integrated settings; and
(6) provides for an informed choice, as defined in section 256B.77, subdivision
2 , paragraph (p), of service and support providers meets the requirements in section
256B.092, subdivision 1b.
(b) When a county is evaluating denials, reductions, or terminations of home and
community-based services under section 256B.49 for an individual, the case manager
shall offer to meet with the individual or the individual's guardian in order to discuss the
prioritization of service needs within the individualized service coordinated services and
support plan. The reduction in the authorized services for an individual due to changes
in funding for waivered services may not exceed the amount needed to ensure medically
necessary services to meet the individual's health, safety, and welfare.

    Sec. 39. Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:
    Subd. 6. Excluded time. "Excluded time" means:
(a) (1) any period an applicant spends in a hospital, sanitarium, nursing home,
shelter other than an emergency shelter, halfway house, foster home, semi-independent
living domicile or services program, residential facility offering care, board and lodging
facility or other institution for the hospitalization or care of human beings, as defined in
section 144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's
shelter, or correctional facility; or any facility based on an emergency hold under sections
253B.05, subdivisions 1 and 2 , and 253B.07, subdivision 6;
(b) (2) any period an applicant spends on a placement basis in a training and
habilitation program, including: a rehabilitation facility or work or employment program
as defined in section 268A.01; or receiving personal care assistance services pursuant to
section 256B.0659; semi-independent living services provided under section 252.275, and
Minnesota Rules, parts 9525.0500 to 9525.0660; or day training and habilitation programs
and assisted living services; and
(c) (3) any placement for a person with an indeterminate commitment, including
independent living.

    Sec. 40. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT
REDESIGN.
By February 1, 2012, the commissioner of human services shall develop a legislative
report with specific recommendations and language for proposed legislation to be effective
July 1, 2012, for the following:
(a) definitions of service and consolidation of standards and rates to the extent
appropriate for all types of medical assistance case management service services, including
targeted case management under Minnesota Statutes, sections 256B.0621, 256B.0924, and
256B.094, and all types of home and community-based waiver case management and case
management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work must be
completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;
(b) recommendations on county of financial responsibility requirements and quality
assurance measures for case management; and
(c) identification of county administrative functions that may remain entwined in
case management service delivery models.

ARTICLE 4

NURSING FACILITIES

    Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 3, is amended to
read:
    Subd. 3. Exceptions authorizing increase in beds; hardship areas. (a) The
commissioner of health, in coordination with the commissioner of human services, may
approve the addition of a new certified bed or the addition of a new licensed and Medicare
and Medicaid-certified nursing home bed beds, under using the following conditions:
criteria and process in this subdivision.
(a) to license or certify a new bed in place of one decertified after July 1, 1993, as
long as the number of certified plus newly certified or recertified beds does not exceed the
number of beds licensed or certified on July 1, 1993, or to address an extreme hardship
situation, in a particular county that, together with all contiguous Minnesota counties, has
fewer nursing home beds per 1,000 elderly than the number that is ten percent higher than
the national average of nursing home beds per 1,000 elderly individuals. For the purposes
of this section, the national average of nursing home beds shall be the most recent figure
that can be supplied by the federal Centers for Medicare and Medicaid Services and the
number of elderly in the county or the nation shall be determined by the most recent
federal census or the most recent estimate of the state demographer as of July 1, of each
year of persons age 65 and older, whichever is the most recent at the time of the request for
replacement. An extreme hardship situation can only be found after the county documents
the existence of unmet medical needs that cannot be addressed by any other alternatives;
(b) The commissioner, in cooperation with the commissioner of human services,
shall consider the following criteria when determining that an area of the state is a
hardship area with regard to access to nursing facility services:
(1) a low number of beds per 1,000 in a specified area using as a standard beds
per 1,000 persons age 65 and older, in five-year age groups, using data from the most
recent census and population projections, weighted by each group's most recent nursing
home utilization, of the county at the 20th percentile, as determined by the commissioner
of human services;
(2) a high level of out-migration for nursing facility services associated with a
described area from the county or counties of residence to other Minnesota counties, as
determined by the commissioner of human services, using as a standard an amount greater
than the out-migration of the county ranked at the 50th percentile;
(3) an adequate level of availability of noninstitutional long-term care services
measured as public spending for home and community-based long-term care services per
individual age 65 and older, in five-year age groups, using data from the most recent
census and population projections, weighted by each group's most recent nursing home
utilization, as determined by the commissioner of human services, using as a standard an
amount greater than the 50th percentile of counties;
(4) there must be a declaration of hardship resulting from insufficient access to
nursing home beds by local county agencies and area agencies on aging; and
(5) other factors that may demonstrate the need to add new nursing facility beds.
(c) On August 15 of odd-numbered years, the commissioner, in cooperation with
the commissioner of human services, may publish in the State Register a request for
information in which interested parties, using the data provided under section 144A.351,
along with any other relevant data, demonstrate that a specified area is a hardship area
with regard to access to nursing facility services. For a response to be considered, the
commissioner must receive it by November 15. The commissioner shall make responses
to the request for information available to the public and shall allow 30 days for comment.
The commissioner shall review responses and comments and determine if any areas of
the state are to be declared hardship areas.
(d) For each designated hardship area determined in paragraph (c), the commissioner
shall publish a request for proposals in accordance with section 144A.073 and Minnesota
Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the
State Register by March 15 following receipt of responses to the request for information.
The request for proposals must specify the number of new beds which may be added
in the designated hardship area, which must not exceed the number which, if added to
the existing number of beds in the area, including beds in layaway status, would have
prevented it from being determined to be a hardship area under paragraph (b), clause
(1). Beginning July 1, 2011, the number of new beds approved must not exceed 200
beds statewide per biennium. After June 30, 2019, the number of new beds that may be
approved in a biennium must not exceed 300 statewide. For a proposal to be considered,
the commissioner must receive it within six months of the publication of the request for
proposals. The commissioner shall review responses to the request for proposals and
shall approve or disapprove each proposal by the following July 15, in accordance with
section 144A.073 and Minnesota Rules, parts 4655.1070 to 4655.1098. The commissioner
shall base approvals or disapprovals on a comparison and ranking of proposals using
only the criteria in subdivision 4a. Approval of a proposal expires after 18 months
unless the facility has added the new beds using existing space, subject to approval
by the commissioner, or has commenced construction as defined in section 144A.071,
subdivision 1a, paragraph (d). If fewer than 50 percent of the beds in a facility are newly
licensed, after the beds have been added, the operating payment rates previously in effect
shall remain. If 50 percent or more of the beds in a facility are newly licensed after the
approved beds have been added, then determination of operating payment rates shall
be done according to Minnesota Rules, part 9549.0057, using limits determined under
section 256B.441. Determination of external fixed payment rates must be done according
to section 256B.441, subdivision 53. Determinations of property payment rates for
facilities with beds added under this subdivision must be done in the same manner as rate
determinations resulting from projects approved and completed under section 144A.073.
(b) to (e) The commissioner may:
(1) certify or license new beds in a new facility that is to be operated by the
commissioner of veterans affairs or when the costs of constructing and operating the new
beds are to be reimbursed by the commissioner of veterans affairs or the United States
Veterans Administration; and
(c) to (2) license or certify beds in a facility that has been involuntarily delicensed or
decertified for participation in the medical assistance program, provided that an application
for relicensure or recertification is submitted to the commissioner by an organization that
is not a related organization as defined in section 256B.441, subdivision 34, to the prior
licensee within 120 days after delicensure or decertification;.
(d) to certify two existing beds in a facility with 66 licensed beds on January 1, 1994,
that had an average occupancy rate of 98 percent or higher in both calendar years 1992 and
1993, and which began construction of four attached assisted living units in April 1993; or
(e) to certify four existing beds in a facility in Winona with 139 beds, of which 129
beds are certified.

    Sec. 2. Minnesota Statutes 2010, section 144D.08, is amended to read:
144D.08 UNIFORM CONSUMER INFORMATION GUIDE.
All housing with services establishments shall make available to all prospective
and current residents information consistent with the uniform format and the required
components adopted by the commissioner under section 144G.06. This section does not
apply to an establishment registered under section 144D.025, serving the homeless.

    Sec. 3. Minnesota Statutes 2010, section 256B.19, subdivision 1e, is amended to read:
    Subd. 1e. Additional local share of certain nursing facility costs. Beginning on
the latter of January 1, 2011, or the first day of the month beginning no less than 45 days
following federal approval, local government entities that own the physical plant or are
the license holders of nursing facilities receiving rate adjustments under section 256B.441,
subdivision 55a, shall be responsible for paying the portion of nonfederal costs calculated
under section 256B.441, subdivision 55a, paragraph (d). This responsibility remains in
effect through the day before the phase-in under section 256B.441, subdivision 55, is
complete. Beginning the day when the phase-in under section 256B.441, subdivision 55,
is complete, local government entities that own the physical plant or are the license holders
of nursing facilities receiving rate adjustments under section 256B.441, subdivision 55a,
shall be responsible for paying the portion of nonfederal costs calculated under section
256B.441, subdivision 55a, paragraph (e). Payments of the nonfederal share shall be
made monthly to the commissioner in amounts determined in accordance with section
256B.441 , subdivision 55a, paragraph (d) (e). Payments for each month beginning in
January 2011 through September 2015 on the effective date of the rate adjustment shall be
due by the 15th day of the following month. If any provider obligated to pay an amount
under this subdivision is more than two months 30 days delinquent in the timely payment
of the monthly installment, the commissioner may withhold payments, penalties, and
interest in accordance with the methods outlined in section 256.9657, subdivision 7a
revoke participation under this subdivision and end payments determined under section
256B.441, subdivision 55a, to the participating nursing facility effective on the first day
of the month following the month in which such notice was mailed. In the event of
revocation, any amounts paid by private residents under this subdivision for days of
service on or after the first day of the month following the month in which such notice was
mailed must be refunded.

    Sec. 4. Minnesota Statutes 2010, section 256B.431, subdivision 2t, is amended to read:
    Subd. 2t. Payment limitation. For services rendered on or after July 1, 2003,
for facilities reimbursed under this section or section 256B.434 chapter, the Medicaid
program shall only pay a co-payment during a Medicare-covered skilled nursing facility
stay if the Medicare rate less the resident's co-payment responsibility is less than the
Medicaid RUG-III case-mix payment rate, or, beginning January 1, 2012, the Medicaid
RUG-IV case-mix payment rate. The amount that shall be paid by the Medicaid program
is equal to the amount by which the Medicaid RUG-III or RUG-IV case-mix payment
rate exceeds the Medicare rate less the co-payment responsibility. Health plans paying
for nursing home services under section 256B.69, subdivision 6a, may limit payments as
allowed under this subdivision.

    Sec. 5. Minnesota Statutes 2010, section 256B.438, subdivision 1, is amended to read:
    Subdivision 1. Scope. This section establishes the method and criteria used to
determine resident reimbursement classifications based upon the assessments of residents
of nursing homes and boarding care homes whose payment rates are established under
section 256B.431, 256B.434, or 256B.435 256B.441 or any other section. Resident
reimbursement classifications shall be established according to the 34 group, resource
utilization groups, version III or RUG-III model as described in section 144.0724.
Reimbursement classifications established under this section shall be implemented
after June 30, 2002, but no later than January 1, 2003. Reimbursement classifications
established under this section shall be implemented no earlier than six weeks after the
commissioner mails notices of payment rates to the facilities. Effective January 1, 2012,
resident reimbursement classifications shall be established according to the 48 group,
resource utilization groups, RUG-IV model under section 144.0724.

    Sec. 6. Minnesota Statutes 2010, section 256B.438, subdivision 3, is amended to read:
    Subd. 3. Case mix indices. (a) The commissioner of human services shall assign a
case mix index to each resident class based on the Centers for Medicare and Medicaid
Services staff time measurement study and adjusted for Minnesota-specific wage indices.
The case mix indices assigned to each resident class shall be published in the Minnesota
State Register at least 120 days prior to the implementation of the 34 group, RUG-III
resident classification system.
(b) An index maximization approach shall be used to classify residents.
(c) After implementation of the revised case mix system, the commissioner of
human services may annually rebase case mix indices and base rates using more current
data on average wage rates and staff time measurement studies. This rebasing shall be
calculated under subdivision 7, paragraph (b). The commissioner shall publish in the
Minnesota State Register adjusted case mix indices at least 45 days prior to the effective
date of the adjusted case mix indices.
(d) Upon implementation of the 48-group RUG-IV resident classification system, the
commissioner of human services shall assign a case mix index to each resident class based
on the Centers for Medicare and Medicaid Services staff time measurement study. The
case mix indices assigned to each resident class shall be published in the State Register at
least 120 days prior to the implementation of the RUG-IV resident classification system.

    Sec. 7. Minnesota Statutes 2010, section 256B.438, subdivision 4, is amended to read:
    Subd. 4. Resident assessment schedule. (a) Nursing facilities shall conduct and
submit case mix assessments according to the schedule established by the commissioner
of health under section 144.0724, subdivisions 4 and 5.
(b) The resident reimbursement classifications established under section 144.0724,
subdivision 3 , shall be effective the day of admission for new admission assessments.
The effective date for significant change assessments shall be the assessment reference
date. The effective date for annual and quarterly assessments shall be the first day of the
month following assessment reference date.
(c) Effective October 1, 2006, the commissioner shall rebase payment rates
to account for the change in the resident assessment schedule in section 144.0724,
subdivision 4, paragraph (b), clause (4), in a facility specific budget neutral manner,
according to subdivision 7, paragraph (b).
(d) Effective January 1, 2012, the commissioner shall determine payment rates
to account for the transition to RUG-IV, in a facility-specific, revenue-neutral manner,
according to subdivision 8, paragraph (b).

    Sec. 8. Minnesota Statutes 2010, section 256B.438, is amended by adding a
subdivision to read:
    Subd. 8. Rate determination upon transition to RUG-IV payment rates. (a) The
commissioner of human services shall determine payment rates at the time of transition
to the RUG-IV-based payment model in a facility-specific, revenue-neutral manner. To
transition from the current calculation methodology to the RUG-IV-based methodology,
nursing facilities shall report to the commissioner of human services the private pay
and Medicaid resident days classified according to the categories defined in subdivision
3, paragraphs (a) and (d), for the six-month reporting period ending June 30, 2011. This
report must be submitted to the commissioner, in a form prescribed by the commissioner,
by August 15, 2011. The commissioner of human services shall use this data to compute
the standardized days for the RUG-III and RUG-IV classification systems.
(b) The commissioner of human services shall determine the case mix adjusted
component for the January 1, 2012, rate as follows:
(1) using the September 30, 2010, cost report, determine the case mix portion of the
operating cost for each facility;
(2) multiply the 36 operating payment rates in effect on December 31, 2011, by the
number of private pay and Medicaid resident days assigned to each group for the reporting
period ending June 30, 2011, and compute the total;
(3) compute the product of the amounts in clauses (1) and (2);
(4) determine the private pay and Medicaid RUG standardized days for the reporting
period ending June 30, 2011, using the new indices calculated under subdivision 3,
paragraph (d);
(5) divide the amount determined in clause (3) by the amount in clause (4), which
shall be the default rate (DDF) unadjusted case mix component of the rate under the
RUG-IV method; and
(6) determine the case mix adjusted component of each operating rate by multiplying
the default rate (DDF) unadjusted case mix component by the case mix weight in
subdivision 3, paragraph (d), for each RUG-IV group.
(c) The noncase mix components will be allocated to each RUG group as a constant
amount to determine the operating payment rate.

    Sec. 9. Minnesota Statutes 2010, section 256B.441, subdivision 55a, is amended to
read:
    Subd. 55a. Alternative to phase-in for publicly owned nursing facilities. (a) For
operating payment rates implemented between January 1, 2011, and September 30, 2015,
the first day of the month beginning no less than 45 days following federal approval,
and the day before the phase-in under subdivision 55 is complete, the commissioner
shall allow nursing facilities whose physical plant is owned or whose license is held by a
city, county, or hospital district to apply for a higher payment rate under this section if
the local government entity agrees to pay a specified portion of the nonfederal share
of medical assistance costs. Nursing facilities that apply shall be eligible to select an
operating payment rate, with a weight of 1.00, up to the rate calculated in subdivision 54,
without application of the phase-in under subdivision 55. The rates for the other RUG's
levels RUGS shall be computed as provided under subdivision 54.
(b) For operating payment rates implemented beginning the day when the phase-in
under subdivision 55 is complete, the commissioner shall allow nursing facilities whose
physical plant is owned or whose license is held by a city, county, or hospital district to
apply for a higher payment rate under this section if the local government entity agrees
to pay a specified portion of the nonfederal share of medical assistance costs. Nursing
facilities that apply are eligible to select an operating payment rate, with a weight of 1.00,
up to an amount determined by the commissioner to be allowable under the Medicare upper
payment limit test. The rates for the other RUGS shall be computed under subdivision 54.
(b) (c) Rates determined under this subdivision shall take effect beginning on the
latter of January 1, 2011, or the first day of the month beginning no less than 45 days
following federal approval, based on cost reports for the rate year ending September 30,
2009, and in future rate years, rates determined for nursing facilities participating under
this subdivision shall take effect on October 1 of each year, based on the most recent
available cost report.
(c) (d) Eligible nursing facilities that wish to participate under this subdivision shall
make an application to the commissioner by September 30, 2010, or by June 30 of any
subsequent year. Participation under this subdivision is irrevocable. If paragraph (a) does
not result in a rate greater than what would have been provided without application of this
subdivision, a facility's rates shall be calculated as otherwise provided and no payment by
the local government entity shall be required under paragraph (d).
(d) (e) For each participating nursing facility, the public entity that owns the physical
plant or is the license holder of the nursing facility shall pay to the state the entire
nonfederal share of medical assistance payments received as a result of the difference
between the nursing facility's payment rate under subdivision 54, paragraph (a) or (b),
and the rates that the nursing facility would otherwise be paid without application of this
subdivision under subdivision 54 or 55 as determined by the commissioner.
(e) (f) The commissioner may, at any time, reduce the payments under this
subdivision based on the commissioner's determination that the payments shall cause
nursing facility rates to exceed the state's Medicare upper payment limit or any other
federal limitation. If the commissioner determines a reduction is necessary, the
commissioner shall reduce all payment rates for participating nursing facilities by a
percentage applied to the amount of increase they would otherwise receive under this
subdivision and shall notify participating facilities of the reductions. If payments to a
nursing facility are reduced, payments under section 256B.19, subdivision 1e, shall be
reduced accordingly.

    Sec. 10. REPEALER.
Minnesota Statutes 2010, section 144A.073, subdivisions 4 and 5, are repealed.

ARTICLE 5

TECHNICAL

    Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 5a, is amended to
read:
    Subd. 5a. Cost estimate of a moratorium exception project. (a) For the
purposes of this section and section 144A.073, the cost estimate of a moratorium
exception project shall include the effects of the proposed project on the costs of the state
subsidy for community-based services, nursing services, and housing in institutional
and noninstitutional settings. The commissioner of health, in cooperation with the
commissioner of human services, shall define the method for estimating these costs in the
permanent rule implementing section 144A.073. The commissioner of human services
shall prepare an estimate of the total state annual long-term costs of each moratorium
exception proposal.
(b) The interest rate to be used for estimating the cost of each moratorium exception
project proposal shall be the lesser of either the prime rate plus two percentage points, or
the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan
Mortgage Corporation plus two percentage points as published in the Wall Street Journal
and in effect 56 days prior to the application deadline. If the applicant's proposal uses this
interest rate, the commissioner of human services, in determining the facility's actual
property-related payment rate to be established upon completion of the project must use
the actual interest rate obtained by the facility for the project's permanent financing up to
the maximum permitted under subdivision 6 Minnesota Rules, part 9549.0060, subpart 6.
The applicant may choose an alternate interest rate for estimating the project's cost.
If the applicant makes this election, the commissioner of human services, in determining
the facility's actual property-related payment rate to be established upon completion of the
project, must use the lesser of the actual interest rate obtained for the project's permanent
financing or the interest rate which was used to estimate the proposal's project cost. For
succeeding rate years, the applicant is at risk for financing costs in excess of the interest
rate selected.