Bill Text: MN HF767 | 2013-2014 | 88th Legislature | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Omnibus Department of Human Services continuing care policy bill.

Sponsorship: Slight Partisan Bill (Democrat 3-1)

Status: (Passed) 2013-05-20 - Secretary of State Chapter 63 05/16/13 [HF767 Detail]

Download: Minnesota-2013-HF767-Introduced.html

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A bill for an act

relating to human services; making changes to continuing care provisions;
modifying provisions related to advisory task forces, nursing homes, resident
relocation, medical assistance, long-term care consultation services, assessments,
and reporting of maltreatment;amending Minnesota Statutes 2012, sections
15.014, subdivision 2; 144A.071, subdivision 4d; 144A.161; 256B.057,
subdivision 9; 256B.0652, subdivision 5; 256B.0911, subdivisions 2b, 3, 3a, 6;
256B.092, subdivision 7; 256B.441, subdivisions 1, 43, 63; 256B.49, subdivision
14; 256B.492; 626.557, subdivision 10; repealing Minnesota Statutes 2012,
section 256B.437, subdivision 8; Laws 2012, chapter 216, article 11, section 31.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

    Section 1. Minnesota Statutes 2012, section 15.014, subdivision 2, is amended to read:
    Subd. 2. Creation; limitations. A commissioner of a state department, a state board
or other agency having the powers of a board as defined in section 15.012, may create
advisory task forces to advise the commissioner or agency on specific programs or topics
within the jurisdiction of the department or agency. A task force so created shall have
no more than 15 members. The task force shall expire and the terms and removal of
members shall be as provided in section 15.059, subdivision 6. The members of no more
than four task forces created pursuant to this section in a department or agency may be
paid expenses in the same manner and amount as authorized by the commissioner's plan
adopted according to section 43A.18, subdivision 2, notwithstanding task forces mandated
by court order. No member of a task force shall be compensated for services in a manner
not provided for in statute. A commissioner, board, council, committee, or other state
agency may not create any other multimember agency unless specifically authorized by
statute or unless the creation of the agency is authorized by federal law as a condition
precedent to the receipt of federal money.

    Sec. 2. Minnesota Statutes 2012, section 144A.071, subdivision 4d, is amended to read:
    Subd. 4d. Consolidation of nursing facilities. (a) The commissioner of health,
in consultation with the commissioner of human services, may approve a request for
consolidation of nursing facilities which includes the closure of one or more facilities
and the upgrading of the physical plant of the remaining nursing facility or facilities,
the costs of which exceed the threshold project limit under subdivision 2, clause (a).
The commissioners shall consider the criteria in this section, section 144A.073, and
section 256B.437, in approving or rejecting a consolidation proposal. In the event the
commissioners approve the request, the commissioner of human services shall calculate a
property rate adjustment according to clauses (1) to (3):
(1) the closure of beds shall not be eligible for a planned closure rate adjustment
under section 256B.437, subdivision 6;
(2) the construction project permitted in this clause shall not be eligible for a
threshold project rate adjustment under section 256B.434, subdivision 4f, or a moratorium
exception adjustment under section 144A.073; and
(3) the property payment rate for a remaining facility or facilities shall be increased
by an amount equal to 65 percent of the projected net cost savings to the state calculated in
paragraph (b), divided by the state's medical assistance percentage of medical assistance
dollars, and then divided by estimated medical assistance resident days, as determined
in paragraph (c), of the remaining nursing facility or facilities in the request in this
paragraph. The rate adjustment is effective on the later of the first day of the month
following completion of the construction upgrades in the consolidation plan or the first
day of the month following the complete closure of a facility designated for closure in the
consolidation plan. If more than one facility is receiving upgrades in the consolidation
plan, each facility's date of construction completion must be evaluated separately.
(b) For purposes of calculating the net cost savings to the state, the commissioner
shall consider clauses (1) to (7):
(1) the annual savings from estimated medical assistance payments from the net
number of beds closed taking into consideration only beds that are in active service on the
date of the request and that have been in active service for at least three years;
(2) the estimated annual cost of increased case load of individuals receiving services
under the elderly waiver;
(3) the estimated annual cost of elderly waiver recipients receiving support under
group residential housing;
(4) the estimated annual cost of increased case load of individuals receiving services
under the alternative care program;
(5) the annual loss of license surcharge payments on closed beds;
(6) the savings from not paying planned closure rate adjustments that the facilities
would otherwise be eligible for under section 256B.437; and
(7) the savings from not paying property payment rate adjustments from submission
of renovation costs that would otherwise be eligible as threshold projects under section
256B.434, subdivision 4f .
(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
assistance resident days of the remaining facility or facilities shall be computed assuming
95 percent occupancy multiplied by the historical percentage of medical assistance
resident days of the remaining facility or facilities, as reported on the facility's or facilities'
most recent nursing facility statistical and cost report filed before the plan of closure
is submitted, multiplied by 365.
(d) For purposes of net cost of savings to the state in paragraph (b), the average
occupancy percentages will be those reported on the facility's or facilities' most recent
nursing facility statistical and cost report filed before the plan of closure is submitted, and
the average payment rates shall be calculated based on the approved payment rates in
effect at the time the consolidation request is submitted.
(e) To qualify for the property payment rate adjustment under this provision, the
closing facilities shall:
(1) submit an application for closure according to section 256B.437, subdivision
3; and
(2) follow the resident relocation provisions of section 144A.161.
(f) The county or counties in which a facility or facilities are closed under this
subdivision shall not be eligible for designation as a hardship area under section 144A.071,
subdivision 3, for five years from the date of the approval of the proposed consolidation.
The applicant shall notify the county of this limitation and the county shall acknowledge
this in a letter of support.

    Sec. 3. Minnesota Statutes 2012, section 144A.161, is amended to read:
144A.161 NURSING HOME AND BOARDING CARE HOME RESIDENT
RELOCATION.
    Subdivision 1. Definitions. The definitions in this subdivision apply to subdivisions
2 to 10.
(a) "Change in operations" means any alteration in operations which would require
or encourage the relocation of residents.
(b) "Closure" or "closing" means the cessation of operations of a facility and the
delicensure and decertification of all beds within the facility.
(b) "Curtailment," "reduction," or "Change" refers to any change in operations which
would result in or encourage the relocation of residents.
(c) "Facility" means a nursing home licensed pursuant to this chapter, or a certified
boarding care home licensed pursuant to sections 144.50 to 144.56. "Contact information"
means name, address, and telephone number and, when available, e-mail address and
facsimile number.
(d) "Licensee" means the owner of the facility or the owner's designee or the
commissioner of health for a facility in receivership.
(e) (d) "County social services agency" means the county or multicounty social
service agency authorized under sections 393.01 and 393.07, as the agency responsible for
providing social services for the county in which the nursing home facility is located.
(e) "Facility" means a nursing home licensed pursuant to this chapter, or a boarding
care home licensed pursuant to sections 144.50 to 144.56.
(f) "Licensee" means the owner of the facility or the owner's designee or the
commissioner of health for a facility in receivership.
(f) (g) "Plan" or "relocation plan" means a description of the process developed
under subdivision 3, paragraph (b), for the relocation of residents in cases of a facility
closure, curtailment, reduction, or change in operations in a facility and the subsequent
relocation of residents.
(h) "Reduction" means a decrease in the number of beds that would require or
encourage the relocation of residents.
(g) (i) "Relocation" means the discharge of a resident and movement of the resident
to another facility or living arrangement as a result of the closing, curtailment, reduction,
or change in operations of a nursing home or boarding care home facility.
(j) "Responsible party" means an individual acting as a legal representative for the
resident.
    Subd. 1a. Scope. Where a facility is undertaking a closure, curtailment, reduction,
or change in operations, or where a housing with services unit registered under chapter
144D is closed because the space that it occupies is being replaced by a nursing facility
bed that is being reactivated from layaway status, the facility and the county social
services agency must comply with the requirements of this section.
    Subd. 2. Initial notice from licensee. (a) A licensee shall notify the following
parties in writing when there is an intent to close or curtail, reduce, or change operations
which that would result in require or encourage the relocation of residents:
(1) the commissioner of health;
(2) the commissioner of human services;
(3) the county social services agency;
(4) the Office of Ombudsman for Long-Term Care; and
(5) the Office of Ombudsman for Mental Health and Developmental Disabilities.; and
(6) the managed care organizations contracting with Minnesota health care programs
within the county where the nursing facility is located.
(b) The written notice shall include the names, telephone numbers, facsimile
numbers, and e-mail addresses contact information of the persons in the facility
responsible for coordinating the licensee's efforts in the planning process, and the number
of residents potentially affected by the closure or curtailment, reduction, or change in
operations. Only the copy of the notice provided to the county social services agency shall
include a complete resident census, including resident name, date of birth, Social Security
number, and medical assistance identification number if it is available.
(c) For a facility that is reducing or changing operations, after providing written
notice under this section subdivision 5a, and prior to admission, the facility must fully
inform prospective residents and their families responsible parties of the intent to close or
curtail, reduce, or change operations, and of the relocation plan.
(d) A closing facility is prohibited from admitting any new residents on or after the
date of the written notice provided under subdivision 5a.
    Subd. 3. Planning process. (a) The county social services agency shall, within
five working days of receiving initial notice of the licensee's intent to close or curtail,
reduce, or change operations, provide the licensee and all parties identified in subdivision
2, paragraph (a), with the names, telephone numbers, facsimile numbers, and e-mail
addresses contact information of those persons responsible for coordinating county social
services agency efforts in the planning process.
(b) Within ten working days of receipt of the notice under subdivision 2, paragraph
(a), the county social services agency and licensee shall meet to develop the relocation
plan. The county social services agency shall inform the Departments Department of
Health and the Department of Human Services, the Office of Ombudsman for Long-Term
Care, and the Office of Ombudsman for Mental Health and Developmental Disabilities of
the date, time, and location of the meeting so that their representatives may attend. The
relocation plan must be completed within no later than 45 days of after receipt of the initial
notice in subdivision 2, paragraph (a). However, the plan may be finalized on an earlier
schedule agreed to by all parties. To the extent practicable, consistent with requirements
to protect the safety and health of residents, the commissioner may authorize the planning
process under this subdivision to occur concurrent with the 60-day notice required under
subdivision 5a. The plan shall:
(1) identify the expected date of closure, curtailment, reduction, or change in
operations;
(2) outline the process for public notification of the closure, curtailment, reduction,
or change in operations;
(3) identify efforts that will be made to include other stakeholders in the relocation
process;
(4) outline the process to ensure 60-day advance written notice to residents, family
members, and designated representatives;
(5) present an aggregate description of the resident population remaining to be
relocated and the population's needs;
(6) outline the individual resident assessment process to be utilized;
(7) identify an inventory of available relocation options and resources, including
home and community-based services;
(8) identify a timeline for submission of the list identified in subdivision 5c,
paragraph (b);
(9) (8) identify a schedule for the timely completion of each element of the plan; and
(10) (9) identify the steps the licensee and the county social services agency will
take to address the relocation needs of individual residents who may be difficult to place
due to specialized care needs such as behavioral health problems.; and
(10) identify the steps needed to share information and coordinate relocation efforts
with managed care organizations.
(c) All parties to the plan shall refrain from any public notification of the intent to
close or curtail, reduce, or change operations until a relocation plan has been established
and the notice in subdivision 5a is given. If the planning process occurs concurrently with
the 60-day notice period, this requirement does not apply once 60-day notice is given.
    Subd. 4. Responsibilities of licensee for resident relocations. The licensee shall
provide for the safe, orderly, and appropriate relocation of residents. The licensee and
facility staff shall cooperate with representatives from the county social services agency,
the Department of Health, the Department of Human Services, the Office of Ombudsman
for Long-Term Care, and the Office of Ombudsman for Mental Health and Developmental
Disabilities in planning for and implementing the relocation of residents.
    Subd. 5. Licensee responsibilities prior related to relocation sending the notice
in subdivision 5a. (a) The licensee shall establish an interdisciplinary team responsible
for coordinating and implementing the plan. The interdisciplinary team shall include
representatives from the county social services agency, the Office of Ombudsman for
Long-Term Care, the Office of the Ombudsman for Mental Health and Developmental
Disabilities, facility staff that provide direct care services to the residents, and facility
administration.
(b) Concurrent with the notice provided in subdivision 5a, the licensee shall
provide a an updated resident census summary document to the county social services
agency, the Ombudsman for Long-Term Care, and the Ombudsman for Mental Health
and Developmental Disabilities that includes the following information on each resident
to be relocated:
(1) resident name;
(2) date of birth;
(3) Social Security number;
(4) payment source and medical assistance identification number, if applicable;
(5) county of financial responsibility if the resident is enrolled in a Minnesota health
care program;
(6) date of admission to the facility;
(7) all current diagnoses;
(8) the name of and contact information for the resident's physician;
(9) the name and contact information for the resident's family or other designated
representative responsible party;
(10) the names name of and contact information for any case managers manager,
managed care coordinator, or other care coordinator, if known; and
(11) information on the resident's status related to commitment and probation.; and
(12) the name of the managed care organization in which the resident is enrolled,
if known.
(c) The licensee shall consult with the county social services agency on the
availability and development of available resources and on the resident relocation process.
    Subd. 5a. Administrator and licensee responsibilities responsibility to provide
notice. At least 60 days before the proposed date of closing, curtailment, reduction, or
change in operations as agreed to in the plan, the licensee administrator shall send a
written notice of closure or curtailment, reduction, or change in operations to each resident
being relocated, the resident's family member or designated representative responsible
party, and the resident's managed care organization if it is known, the county social
services agency, the commissioner of health, the commissioner of human services, the
Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental
Health and Developmental Disabilities, the resident's attending physician, and, in the case
of a complete facility closure, the Centers for Medicare and Medicaid Services regional
office designated representative. The notice must include the following:
(1) the date of the proposed closure, curtailment, reduction, or change in operations;
(2) the name, address, telephone number, facsimile number, and e-mail address
contact information of the individual or individuals in the facility responsible for providing
assistance and information;
(3) notification of upcoming meetings for residents, families and designated
representatives responsible parties, and resident and family councils to discuss the plan
for relocation of residents;
(4) the name, address, and telephone number contact information of the county
social services agency contact person; and
(5) the name, address, and telephone number contact information of the Office of
Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and
Developmental Disabilities.
The notice must comply with all applicable state and federal requirements for notice
of transfer or discharge of nursing home residents.
    Subd. 5b. Licensee responsibility regarding medical information. The licensee
shall request the attending physician provide or arrange for the release of medical
information needed to update resident medical records and prepare all required forms
and discharge summaries.
    Subd. 5c. Licensee responsibility regarding placement information. (a) The
licensee shall provide sufficient preparation to residents each resident to ensure safe, and
orderly, and appropriate discharge and relocation. The licensee shall assist residents
each resident in finding placements that respond to personal preferences, such as desired
geographic location take into consideration quality, services, location, the resident's needs
and choices, and the best interests of each resident.
(b) The licensee shall prepare a resource list with several relocation options for each
resident. The list must contain the following information for each relocation option,
when applicable:
(1) the name, address, and telephone and facsimile numbers of each facility with
appropriate, available beds or services;
(2) the certification level of the available beds;
(3) the types of services available; and
(4) the name, address, and telephone and facsimile numbers of appropriate available
home and community-based placements, services, and settings or other options for
individuals with special needs.
The list shall be made available to residents and their families or designated
representatives, and upon request to the Office of Ombudsman for Long-Term Care, the
Office of Ombudsman for Mental Health and Developmental Disabilities, and the county
social services agency.
(c) The Senior LinkAge line may make available via a Web site the name, address,
and telephone and facsimile numbers of each facility with available beds, the certification
level of the available beds, the types of services available, and the number of beds that are
available as updated daily by the listed facilities. The licensee must provide residents,
their families or designated representatives, the Office of Ombudsman for Long-Term
Care, the Office of Ombudsman for Mental Health and Developmental Disabilities, and
the county social services agency with the toll-free number and Web site address for
the Senior LinkAge line.
    Subd. 5d. Licensee responsibility to meet with residents and families responsible
parties. Following the establishment of the plan, the licensee shall conduct meetings with
residents, families and designated representatives responsible parties, and resident and
family councils to notify them of the process for resident relocation. Representatives from
the local county social services agency, the Office of Ombudsman for Long-Term Care,
the Office of Ombudsman for Mental Health and Developmental Disabilities, managed
care organizations with residents in the facility, the commissioner of health, and the
commissioner of human services shall receive advance notice of the meetings.
    Subd. 5e. Licensee responsibility for site visits. The licensee shall assist
residents desiring to make site visits to facilities with available beds or other appropriate
living options to which the resident may relocate, unless it is medically inadvisable, as
documented by the attending physician in the resident's care record. The licensee shall
provide or arrange make available to the resident at no charge transportation for up to
three site visits to facilities or other living options within a 50-mile radius to which the
resident may relocate, or within a larger radius if no suitable options are available within
50 miles. The licensee shall provide available written materials to residents on a potential
new facility or living option the county or contiguous counties.
    Subd. 5f. Licensee responsible responsibility for resident property, funds, and
telephone service communication devices. (a) The licensee shall complete an inventory
of resident personal possessions and provide a copy of the final inventory to the resident
and the resident's designated representative responsible party prior to relocation. The
licensee shall be responsible for the transfer of the resident's possessions for all relocations
within a 50-mile radius of the facility, or within a larger radius if no suitable options are
available within 50 miles to a selected new location within the county or contiguous
counties. The licensee shall complete the transfer of resident possessions in a timely
manner, but no later than the date of the actual physical relocation of the resident.
(b) The licensee shall complete a final accounting of personal funds held in trust
by the facility and provide a copy of this accounting to the resident and the resident's
family or the resident's designated representative responsible party. The licensee shall be
responsible for the transfer of all personal funds held in trust by the facility. The licensee
shall complete the transfer of all personal funds in a timely manner.
(c) The licensee shall assist residents with the transfer and reconnection of service
for telephones or, for residents who are deaf or blind, other personal communication
devices or services. The licensee shall pay the costs associated with reestablishing
service for telephones or other personal communication devices or services, such as
connection fees or other onetime charges. The transfer or and reconnection of personal
communication devices or services shall be completed in a timely manner.
    Subd. 5g. Licensee responsibilities for final written discharge notice and records
transfer. (a) The licensee shall provide the resident, the resident's family or designated
representative responsible parties, the resident's managed care organization, if known,
and the resident's attending physician with a final written discharge notice prior to the
relocation of the resident. The notice must:
(1) be provided seven days prior to the actual relocation, unless the resident agrees
to waive the right to advance notice; and
(2) identify the effective date of the anticipated relocation and the destination to
which the resident is being relocated.
(b) The licensee shall provide the receiving facility or other health, housing, or care
entity with complete and accurate resident records including contact information on for
family members, designated representatives responsible parties, guardians, social service
or other caseworkers, or other contact information and managed care coordinators. These
records must also include all information necessary to provide appropriate medical care
and social services. This includes, but is not limited to, information on preadmission
screening, Level I and Level II screening, minimum data set (MDS), and all other
assessments, current resident diagnoses, social, behavioral, and medication information,
required forms, and discharge summaries.
(c) For residents with special care needs, the licensee shall consult with the receiving
facility or other placement entity and provide staff training or other preparation as needed
to assist in providing for the special needs.
    Subd. 6. Responsibilities of licensee during relocation. (a) The licensee shall, at
no charge to the resident, make arrangements or provide for the transportation of residents
to the new facility or placement within a 50-mile radius, or within a larger radius if no
suitable options are available within 50 miles location within the county or contiguous
counties. The licensee shall provide a staff person to accompany the resident during
transportation to the new location within the county or contiguous counties, upon request
of the resident, the resident's family, or designated representative responsible party. The
discharge and relocation of residents must comply with all applicable state and federal
requirements and must be conducted in a safe, and orderly, and appropriate manner.
The licensee must ensure that there is no disruption in providing meals, medications, or
treatments of a resident during the relocation process.
(b) Beginning the week following development of the initial relocation plan the
announcement in subdivision 5a, the licensee shall submit weekly status reports to the
commissioners commissioner of health and the commissioner of human services or their
designees, the Ombudsman for Long-Term Care and Ombudsman for Mental Health
and Developmental Disabilities, and to the county social services agency. The status
reports must be submitted in the format required by the commissioner of health and the
commissioner of human services. The initial status report must identify:
(1) the relocation plan developed;
(2) the interdisciplinary team members; and
(3) the number of residents to be relocated.
(c) Subsequent status reports must identify:
(1) any modifications to the plan;
(2) any change of interdisciplinary team members;
(3) the number of residents relocated;
(4) the destination to which residents have been relocated;
(5) the number of residents remaining to be relocated; and
(6) issues or problems encountered during the process and resolution of these issues.
    Subd. 7. Responsibilities of licensee following relocation. The licensee shall retain
or make arrangements for the retention of all remaining resident records for the period
required by law. The licensee shall provide the Department of Health access to these
records. The licensee shall notify the Department of Health of the location of any resident
records that have not been transferred to the new facility or other health care entity.
    Subd. 8. Responsibilities of county social services agency. (a) The county social
services agency shall participate in the meeting as outlined in subdivision 3, paragraph
(b), to develop a relocation plan.
(b) The county social services agency shall designate a representative to the
interdisciplinary team established by the licensee responsible for coordinating the
relocation efforts.
(c) The county social services agency shall serve as a resource in the relocation
process.
(d) Concurrent with the notice sent to residents from the licensee as provided in
subdivision 5a, the county social services agency shall provide written notice to residents,
family, or designated representatives and responsible parties describing:
(1) the county's role in the relocation process and in the follow-up to relocations;
(2) a the county social services agency contact name, address, and telephone number
information; and
(3) the name, address, and telephone number of contact information for the Office
of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health
and Developmental Disabilities.
(e) The county social services agency designee shall meet with appropriate facility
staff to coordinate any assistance in the relocation process. This coordination shall include
participating in group meetings with residents, families, and designated representatives
responsible parties to explain the relocation process.
(f) Beginning from the initial notice given in subdivision 2, the county social services
agency shall monitor compliance with all components of this section and the plan developed
under subdivision 3, paragraph (b). If the licensee is not in compliance, the county
social services agency shall notify the commissioners commissioner of the Departments
Department of of Health and the commissioner of the Department of Human Services.
(g) Except as requested by the resident, family member, or designated representative
or responsible party and within the parameters of the Vulnerable Adults Act, the
county social services agency, in coordination with the commissioner of health and the
commissioner of human services, may halt a relocation that it deems inappropriate or
dangerous to the health or safety of a resident. In situations where a resident relocation
is halted, the county social services agency must notify the resident, family, responsible
parties, Office of the Ombudsman for Long-Term Care and Office of the Ombudsman for
Mental Health and Developmental Disabilities, and resident's managed care organization,
of this action. The county social services agency shall pursue remedies to protect the
resident during the relocation process, including, but not limited to, assisting the resident
with filing an appeal of transfer or discharge, notification of all appropriate licensing
boards and agencies, and other remedies available to the county under section 626.557,
subdivision 10.
(h) A member of the county social services agency staff shall visit follow up
with relocated residents relocated within 100 miles of the county within 30 days after
the relocation. This requirement does not apply to changes in operation where the
facility moved to a new location and residents chose to move to that new location.
The requirement also does not apply to residents admitted after the notice of closure
in subdivision 5a is given and discharged prior to the actual closure change in facility
operations or reduction. County social services agency staff shall interview the resident
and family or designated representative, observe the resident on site, responsible party and
review and discuss pertinent medical or social records with appropriate facility staff to:
(1) assess the adjustment of the resident to the new placement;
(2) recommend services or methods to meet any special needs of the resident; and
(3) identify residents at risk.
(i) The county social services agency may shall conduct subsequent follow-up visits
on-site in cases where the adjustment of the resident to the new placement is in question.
(j) Within 60 days of the completion of the follow-up visits under paragraphs (h) and
(i), the county social services agency shall submit a written summary of the follow-up
work to the Departments Department of Health and the Department of Human Services in
a manner approved by the commissioners.
(k) The county social services agency shall submit to the Departments Department
of Health and the Department of Human Services a report of any issues that may require
further review or monitoring.
(l) The county social services agency shall be responsible for the safe and orderly
relocation of residents in cases where an emergent need arises or when the licensee has
abrogated its responsibilities under the plan.
    Subd. 9. Penalties. Upon the recommendation of the commissioner of health,
the commissioner of human services may eliminate a closure rate adjustment under
subdivision 10 for violations of this section.
    Subd. 10. Facility closure rate adjustment. Upon the request of a closing facility,
the commissioner of human services must allow the facility a closure rate adjustment equal
to a 50 percent payment rate increase to reimburse relocation costs or other costs related to
facility closure. This rate increase is effective on the date the facility's occupancy decreases
to 90 percent of capacity days after the written notice of closure is distributed under
subdivision 5 and shall remain in effect for a period of up to 60 days. The commissioner
shall delay the implementation of rate adjustments under section 256B.437, subdivisions
3, paragraph (b) , and 6, paragraph (a), to offset the cost of this rate adjustment.
    Subd. 11. County costs. The commissioner of human services shall allocate up
to $450 in total state and federal funds per nursing facility bed that is closing, within
the limits of the appropriation specified for this purpose, to be used for relocation costs
incurred by counties for resident relocation under this section or planned closures under
section 256B.437. To be eligible for this allocation, a county in which a nursing facility
closes must provide to the commissioner a detailed statement in a form provided by the
commissioner of additional costs, not to exceed $450 in total state and federal funds per
bed closed, that are directly incurred related to the county's role in the relocation process.

    Sec. 4. Minnesota Statutes 2012, section 256B.057, subdivision 9, is amended to read:
    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid
for a person who is employed and who:
(1) but for excess earnings or assets, meets the definition of disabled under the
Supplemental Security Income program;
(2) meets the asset limits in paragraph (d); and
(3) pays a premium and other obligations under paragraph (e).
    (b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
for medical assistance under this subdivision, a person must have more than $65 of earned
income. Earned income must have Medicare, Social Security, and applicable state and
federal taxes withheld. The person must document earned income tax withholding. Any
spousal income or assets shall be disregarded for purposes of eligibility and premium
determinations.
(c) After the month of enrollment, a person enrolled in medical assistance under
this subdivision who:
(1) is temporarily unable to work and without receipt of earned income due to a
medical condition, as verified by a physician; or
(2) loses employment for reasons not attributable to the enrollee, and is without
receipt of earned income may retain eligibility for up to four consecutive months after the
month of job loss. To receive a four-month extension, enrollees must verify the medical
condition or provide notification of job loss. All other eligibility requirements must be met
and the enrollee must pay all calculated premium costs for continued eligibility.
(d) For purposes of determining eligibility under this subdivision, a person's assets
must not exceed $20,000, excluding:
(1) all assets excluded under section 256B.056;
(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
Keogh plans, and pension plans;
(3) medical expense accounts set up through the person's employer; and
(4) spousal assets, including spouse's share of jointly held assets.
(e) All enrollees must pay a premium to be eligible for medical assistance under this
subdivision, except as provided under clause (5).
(1) An enrollee must pay the greater of a $65 premium or the premium calculated
based on the person's gross earned and unearned income and the applicable family size
using a sliding fee scale established by the commissioner, which begins at one percent of
income at 100 percent of the federal poverty guidelines and increases to 7.5 percent of
income for those with incomes at or above 300 percent of the federal poverty guidelines.
(2) Annual adjustments in the premium schedule based upon changes in the federal
poverty guidelines shall be effective for premiums due in July of each year.
(3) All enrollees who receive unearned income must pay five percent of unearned
income in addition to the premium amount, except as provided under clause (5).
(4) Increases in benefits under title II of the Social Security Act shall not be counted
as income for purposes of this subdivision until July 1 of each year.
(5) Effective July 1, 2009, American Indians are exempt from paying premiums as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
(f) A person's eligibility and premium shall be determined by the local county
agency. Premiums must be paid to the commissioner. All premiums are dedicated to
the commissioner.
(g) Any required premium shall be determined at application and redetermined at
the enrollee's six-month income review or when a change in income or household size is
reported. Enrollees must report any change in income or household size within ten days
of when the change occurs. A decreased premium resulting from a reported change in
income or household size shall be effective the first day of the next available billing month
after the change is reported. Except for changes occurring from annual cost-of-living
increases, a change resulting in an increased premium shall not affect the premium amount
until the next six-month review.
(h) Premium payment is due upon notification from the commissioner of the
premium amount required. Premiums may be paid in installments at the discretion of
the commissioner.
(i) Nonpayment of the premium shall result in denial or termination of medical
assistance unless the person demonstrates good cause for nonpayment. Good cause exists
if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
D, are met. Except when an installment agreement is accepted by the commissioner, all
persons disenrolled for nonpayment of a premium must pay any past due premiums as well
as current premiums due prior to being reenrolled. Nonpayment shall include payment with
a returned, refused, or dishonored instrument. The commissioner may require a guaranteed
form of payment as the only means to replace a returned, refused, or dishonored instrument.
(j) The commissioner shall notify enrollees annually beginning at least 24 months
before the person's 65th birthday of the medical assistance eligibility rules affecting
income, assets, and treatment of a spouse's income and assets that will be applied upon
reaching age 65.
(k) (j) For enrollees whose income does not exceed 200 percent of the federal
poverty guidelines and who are also enrolled in Medicare, the commissioner shall
reimburse the enrollee for Medicare part B premiums under section 256B.0625,
subdivision 15 , paragraph (a).

    Sec. 5. Minnesota Statutes 2012, section 256B.0652, subdivision 5, is amended to read:
    Subd. 5. Authorization; private duty nursing services. (a) All private duty
nursing services shall be authorized by the commissioner or the commissioner's designee.
Authorization for private duty nursing services shall be based on medical necessity and
cost-effectiveness when compared with alternative care options. The commissioner may
authorize medically necessary private duty nursing services in quarter-hour units when:
(1) the recipient requires more individual and continuous care than can be provided
during a skilled nurse visit; or
(2) the cares are outside of the scope of services that can be provided by a home
health aide or personal care assistant.
(b) The commissioner may authorize:
(1) up to two times the average amount of direct care hours provided in nursing
facilities statewide for case mix classification "K" as established by the annual cost report
submitted to the department by nursing facilities in May 1992;
(2) private duty nursing in combination with other home care services up to the total
cost allowed under section 256B.0652, subdivision 6 subdivisions 5 and 7;
(3) up to 16 hours per day if the recipient requires more nursing than the maximum
number of direct care hours as established in clause (1) and the recipient meets the hospital
admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540, but
for the provision of the nursing services, the recipient would require a hospital level of
care as defined in Code of Federal Regulations, title 42, section 440.10.
(c) The commissioner may authorize up to 16 hours per day of medically necessary
private duty nursing services or up to 24 hours per day of medically necessary private duty
nursing services until such time as the commissioner is able to make a determination of
eligibility for recipients who are cooperatively applying for home care services under
the community alternative care program developed under section 256B.49, or until it is
determined by the appropriate regulatory agency that a health benefit plan is or is not
required to pay for appropriate medically necessary health care services. Recipients or their
representatives must cooperatively assist the commissioner in obtaining this determination.
Recipients who are eligible for the community alternative care program may not receive
more hours of nursing under this section and sections 256B.0651, 256B.0653, 256B.0656,
and 256B.0659 than would otherwise be authorized under section 256B.49.

    Sec. 6. Minnesota Statutes 2012, section 256B.0911, subdivision 2b, is amended to read:
    Subd. 2b. Certified assessors. (a) 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. 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 registered nurse
without public health certification with at least two years of home and community-based
experience that has received training and certification specific to assessment and
consultation for long-term care services in the state.

    Sec. 7. Minnesota Statutes 2012, section 256B.0911, subdivision 3, is amended to read:
    Subd. 3. Long-term care consultation team. (a) A long-term care consultation
team shall be established by the county board of commissioners. Two or more counties
may collaborate to establish a joint local consultation team or teams.
(b) Certified assessors must be part of a multidisciplinary long-term care consultation
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, except
for persons leaving regional treatment centers returning to the community when the
county of financial responsibility has been following the person's placement and has been
working with the person to arrange for discharge.
(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.
(e) The lead agency must provide the commissioner with an administrative contact
for communication purposes.

    Sec. 8. Minnesota Statutes 2012, 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 20
calendar days after the date on which an assessment was requested or recommended.
Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
applies to an assessment of a person requesting personal care assistance services and
private duty nursing. 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 lead agency may utilize a team of either the social worker or public health
nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
use certified assessors to conduct the assessment. The consultation team members must
confer regarding the most appropriate care for each individual screened or assessed. For
a person 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, 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. For persons who are to be assessed for elderly waiver customized living
services under section 256B.0915, with the permission of the person being assessed or
the person's designated or legal representative, the client's current or proposed provider
of services may submit a copy of the provider's nursing assessment or written report
outlining its recommendations regarding the client's care needs. The person conducting
the assessment will notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment
prior to the assessment. For a person who is to be assessed for waiver services under
section 256B.092 or 256B.49, with the permission of the person being assessed or the
person's designated legal representative, the person's current provider of services may
submit a written report outlining recommendations regarding the person's care needs
prepared by a direct service employee with a least 20 hours of service to that client. The
person conducting the assessment or reassessment must notify the provider of the date
by which this information is to be submitted. This information shall be provided to the
person conducting the assessment and the person or the person's legal representative, and
must be considered prior to the finalization of the assessment or reassessment.
    (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 a person 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 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 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 an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 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;
    (4) the role of long-term care consultation assessment and support planning in
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);
    (5) information about Minnesota health care programs;
    (6) the person's freedom to accept or reject the recommendations of the team;
    (7) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;
    (8) the certified assessor's decision regarding the person's need for institutional level
of care as determined under criteria established in section 256B.0911, subdivision 4a,
paragraph (d), 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
    (9) the person's right to appeal the certified assessor's decision regarding eligibility
for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and
(b), and incorporating the decision regarding the need for institutional level of care or the
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 brain injury waiver programs under sections 256B.0913,
256B.0915 , and 256B.49 is valid to establish service eligibility for no more than 60
calendar days after the date of assessment.
(j) The effective eligibility start date for programs in paragraph (i) 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
eligibility for programs included in paragraph (i) cannot be prior to the date the most
recent updated assessment is completed.

    Sec. 9. Minnesota Statutes 2012, 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, 256B.434,
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 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 all long-term care consultation and preadmission screening
activity.

    Sec. 10. Minnesota Statutes 2012, 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 a certified assessor
shall be established which shall evaluate the need for the an institutional 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
five 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.
(b) 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 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.
(c) 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.
(d) 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.
(e) 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.
(f) (c) The case manager certified assessor, 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 the assessment. With the permission
of the person being screened assessed or the person's designated legal representative,
the person's current provider of services may submit a written report outlining their
recommendations regarding the person's care needs prepared by a direct service employee
with at least 20 hours of service to that client. The screening team assessor must notify
the provider of the date by which this information is to be submitted. This information
must be provided to the screening team assessor and the person or the person's legal
representative and must be considered prior to the finalization of the screening assessment.
(g) No member of the screening team shall have any direct or indirect service
provider interest in the case.
(h) Nothing in this section shall be construed as requiring the screening team
meeting to be separate from the service planning meeting.

    Sec. 11. Minnesota Statutes 2012, section 256B.441, subdivision 1, is amended to read:
    Subdivision 1. Rebasing of nursing facility operating payment rates. (a) The
commissioner shall rebase nursing facility operating payment rates to align payments to
facilities with the cost of providing care. The rebased operating payment rates shall be
calculated using the statistical and cost report filed by each nursing facility for the report
period ending one year prior to the rate year.
    (b) The new operating payment rates based on this section shall take effect beginning
with the rate year beginning October 1, 2008, and shall be phased in over eight rate years
through October 1, 2015. For each year of the phase-in, the operating payment rates shall
be calculated using the statistical and cost report filed by each nursing facility for the
report period ending one year prior to the rate year.
    (c) Operating payment rates shall be rebased on October 1, 2016, and every two
years after that date.
    (d) Each cost reporting year shall begin on October 1 and end on the following
September 30. Beginning in 2006 2014, a statistical and cost report shall be filed by each
nursing facility by January 15 February 1. Notice of rates shall be distributed by August
15 and the rates shall go into effect on October 1 for one year.
    (e) Effective October 1, 2014, property rates shall be rebased in accordance with
section 256B.431 and Minnesota Rules, chapter 9549. The commissioner shall determine
what the property payment rate for a nursing facility would be had the facility not had its
property rate determined under section 256B.434. The commissioner shall allow nursing
facilities to provide information affecting this rate determination that would have been
filed annually under Minnesota Rules, chapter 9549, and nursing facilities shall report
information necessary to determine allowable debt. The commissioner shall use this
information to determine the property payment rate.

    Sec. 12. Minnesota Statutes 2012, section 256B.441, subdivision 43, is amended to read:
    Subd. 43. Reporting of statistical and cost information. (a) Beginning in 2006,
all nursing facilities shall provide information annually to the commissioner on a form
and in a manner determined by the commissioner. The commissioner may also require
nursing facilities to provide statistical and cost information for a subset of the items in
the annual report on a semiannual basis. Nursing facilities shall report only costs directly
related to the operation of the nursing facility. The facility shall not include costs which
are separately reimbursed by residents, medical assistance, or other payors. Allocations
of costs from central, affiliated, or corporate office and related organization transactions
shall be reported according to section 256B.432. Beginning with the September 30, 2013,
reporting year, the commissioner may shall no longer grant to facilities one extension of
up to 15 days for the filing of this report if the extension is requested by December 15 and
the commissioner determines that the extension will not prevent the commissioner from
establishing rates in a timely manner required by law extensions to the filing deadline.
The commissioner may separately require facilities to submit in a manner specified by
the commissioner documentation of statistical and cost information included in the report
to ensure accuracy in establishing payment rates and to perform audit and appeal review
functions under this section. Facilities shall retain all records necessary to document
statistical and cost information on the report for a period of no less than seven years.
The commissioner may amend information in the report according to subdivision 47.
The commissioner may reject a report filed by a nursing facility under this section if the
commissioner determines that the report has been filed in a form that is incomplete or
inaccurate and the information is insufficient to establish accurate payment rates. In the
event that a complete report is not submitted in a timely manner, the commissioner shall
reduce the reimbursement payments to a nursing facility to 85 percent of amounts due
until the information is filed. The release of withheld payments shall be retroactive for
no more than 90 days. A nursing facility that does not submit a report or whose report is
filed in a timely manner but determined to be incomplete shall be given written notice that
a payment reduction is to be implemented and allowed ten days to complete the report
prior to any payment reduction. The commissioner may delay the payment withhold under
exceptional circumstances to be determined at the sole discretion of the commissioner.
(b) Nursing facilities may, within 12 months of the due date of a statistical and
cost report, file an amendment when errors or omissions in the annual statistical and
cost report are discovered and an amendment would result in a rate increase of at least
0.15 percent of the statewide weighted average operating payment rate and shall, at any
time, file an amendment which would result in a rate reduction of at least 0.15 percent of
the statewide weighted average operating payment rate. The commissioner shall make
retroactive adjustments to the total payment rate of a nursing facility if an amendment is
accepted. Where a retroactive adjustment is to be made as a result of an amended report,
audit findings, or other determination of an incorrect payment rate, the commissioner may
settle the payment error through a negotiated agreement with the facility and a gross
adjustment of the payments to the facility. Retroactive adjustments shall not be applied
to private pay residents. An error or omission for purposes of this item does not include
a nursing facility's determination that an election between permissible alternatives was
not advantageous and should be changed.
(c) If the commissioner determines that a nursing facility knowingly supplied
inaccurate or false information or failed to file an amendment to a statistical and cost report
that resulted in or would result in an overpayment, the commissioner shall immediately
adjust the nursing facility's payment rate and recover the entire overpayment. The
commissioner may also terminate the commissioner's agreement with the nursing facility
and prosecute under applicable state or federal law.

    Sec. 13. Minnesota Statutes 2012, section 256B.441, subdivision 63, is amended to read:
    Subd. 63. Critical access nursing facilities. (a) The commissioner, in consultation
with the commissioner of health, may designate certain nursing facilities as critical access
nursing facilities. The designation shall be granted on a competitive basis, within the
limits of funds appropriated for this purpose.
(b) The commissioner shall request proposals from nursing facilities every two years.
Proposals must be submitted in the form and according to the timelines established by
the commissioner. In selecting applicants to designate, the commissioner, in consultation
with the commissioner of health, and with input from stakeholders, shall develop criteria
designed to preserve access to nursing facility services in isolated areas, rebalance
long-term care, and improve quality.
(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing
facilities designated as critical access nursing facilities:
(1) partial rebasing, with operating payment rates being the sum of 60 percent of the
operating payment rate determined in accordance with subdivision 54 and 40 percent of the
operating payment rate that would have been allowed had the facility not been designated;
(2) enhanced payments for leave days. Notwithstanding section 256B.431,
subdivision 2r, upon designation as a critical access nursing facility, the commissioner
shall limit payment for leave days to 60 percent of that nursing facility's total payment rate
for the involved resident, and shall allow this payment only when the occupancy of the
nursing facility, inclusive of bed hold days, is equal to or greater than 90 percent;
(3) two designated critical access nursing facilities, with up to 100 beds in active
service, may jointly apply to the commissioner of health for a waiver of Minnesota
Rules, part 4658.0500, subpart 2, in order to jointly employ a director of nursing. The
commissioner of health will consider each waiver request independently based on the
criteria under Minnesota Rules, part 4658.0040;
(4) the minimum threshold under section 256B.431, subdivisions 3f, paragraph (a),
and 17e subdivision 15, paragraph (e), shall be 40 percent of the amount that would
otherwise apply; and
(5) notwithstanding subdivision 58, beginning October 1, 2014, the quality-based
rate limits under subdivision 50 shall apply to designated critical access nursing facilities.
(d) Designation of a critical access nursing facility shall be for a period of two
years, after which the benefits allowed under paragraph (c) shall be removed. Designated
facilities may apply for continued designation.
EFFECTIVE DATE.This section is effective the day following final enactment.

    Sec. 14. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
The certified assessor, with the permission of the recipient or the recipient's designated
legal representative, may invite other individuals to attend the assessment. With the
permission of the recipient or the recipient's designated legal representative, the recipient's
current provider of services may submit a written report outlining their recommendations
regarding the recipient's care needs prepared by a direct service employee with at least
20 hours of service to that client. The person conducting the assessment or reassessment
certified assessor must notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment
certified assessor and the person or the person's legal representative and must be
considered prior to the finalization of the assessment or reassessment.
(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 256B.0911, subdivision 4a, paragraph
(d), 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) 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.
(e) The commissioner shall develop criteria to identify recipients whose level of
functioning is reasonably expected to improve and reassess these recipients to establish
a baseline assessment. Recipients who meet these criteria must have a comprehensive
transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
reassessed every six months until there has been no significant change in the recipient's
functioning for at least 12 months. After there has been no significant change in the
recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
informal 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. Counties, case managers, and service providers are responsible for
conducting these reassessments and shall complete the reassessments out of existing funds.

    Sec. 15. Minnesota Statutes 2012, section 256B.492, is amended to read:
256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
WITH DISABILITIES.
(a) Individuals receiving services under a home and community-based waiver under
section 256B.092 or 256B.49 may receive services in the following settings:
(1) an individual's own home or family home;
(2) a licensed adult foster care or child foster care setting of up to five people; and
(3) community living settings as defined in section 256B.49, subdivision 23, where
individuals with disabilities may reside in all of the units in a building of four or fewer
units, and no more than the greater of four or 25 percent of the units in a multifamily
building of more than four units.
(b) The settings in paragraph (a) must not:
(1) be located in a building that is a publicly or privately operated facility that
provides institutional treatment or custodial care;
(2) be located in a building on the grounds of or adjacent to a public or private
institution;
(3) be a housing complex designed expressly around an individual's diagnosis or
disability;
(4) be segregated based on a disability, either physically or because of setting
characteristics, from the larger community; and
(5) have the qualities of an institution which include, but are not limited to:
regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
agreed to and documented in the person's individual service plan shall not result in a
residence having the qualities of an institution as long as the restrictions for the person are
not imposed upon others in the same residence and are the least restrictive alternative,
imposed for the shortest possible time to meet the person's needs.
(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
individuals receive services under a home and community-based waiver as of July 1,
2012, and the setting does not meet the criteria of this section.
(d) Notwithstanding paragraph (c), a program in Hennepin County established as
part of a Hennepin County demonstration project is qualified for the exception allowed
under paragraph (c).
(e) The commissioner shall submit an amendment to the waiver plan no later than
December 31, 2012.

    Sec. 16. Minnesota Statutes 2012, section 626.557, subdivision 10, is amended to read:
    Subd. 10. Duties of county social service agency. (a) Upon receipt of a report from
the common entry point staff, the county social service agency shall immediately assess
and offer emergency and continuing protective social services for purposes of preventing
further maltreatment and for safeguarding the welfare of the maltreated vulnerable adult.
The county shall do this using a standardized tool made available by the commissioner.
The information entered by the county into this standardized tool must be accessible to the
Department of Human Services for its use. In cases of suspected sexual abuse, the county
social service agency shall immediately arrange for and make available to the vulnerable
adult appropriate medical examination and treatment. When necessary in order to protect
the vulnerable adult from further harm, the county social service agency shall seek authority
to remove the vulnerable adult from the situation in which the maltreatment occurred. The
county social service agency may also investigate to determine whether the conditions
which resulted in the reported maltreatment place other vulnerable adults in jeopardy of
being maltreated and offer protective social services that are called for by its determination.
(b) County social service agencies may enter facilities and inspect and copy records
as part of an investigation. The county social service agency has access to not public
data, as defined in section 13.02, and medical records under sections 144.291 to 144.298,
that are maintained by facilities to the extent necessary to conduct its investigation. The
inquiry is not limited to the written records of the facility, but may include every other
available source of information.
(c) When necessary in order to protect a vulnerable adult from serious harm, the
county social service agency shall immediately intervene on behalf of that adult to help
the family, vulnerable adult, or other interested person by seeking any of the following:
(1) a restraining order or a court order for removal of the perpetrator from the
residence of the vulnerable adult pursuant to section 518B.01;
(2) the appointment of a guardian or conservator pursuant to sections 524.5-101 to
524.5-502 , or guardianship or conservatorship pursuant to chapter 252A;
(3) replacement of a guardian or conservator suspected of maltreatment and
appointment of a suitable person as guardian or conservator, pursuant to sections
524.5-101 to 524.5-502; or
(4) a referral to the prosecuting attorney for possible criminal prosecution of the
perpetrator under chapter 609.
The expenses of legal intervention must be paid by the county in the case of indigent
persons, under section 524.5-502 and chapter 563.
In proceedings under sections 524.5-101 to 524.5-502, if a suitable relative or
other person is not available to petition for guardianship or conservatorship, a county
employee shall present the petition with representation by the county attorney. The county
shall contract with or arrange for a suitable person or organization to provide ongoing
guardianship services. If the county presents evidence to the court exercising probate
jurisdiction that it has made a diligent effort and no other suitable person can be found,
a county employee may serve as guardian or conservator. The county shall not retaliate
against the employee for any action taken on behalf of the ward or protected person even
if the action is adverse to the county's interest. Any person retaliated against in violation
of this subdivision shall have a cause of action against the county and shall be entitled to
reasonable attorney fees and costs of the action if the action is upheld by the court.

    Sec. 17. REPEALER.
(a) Minnesota Statutes 2012, section 256B.437, subdivision 8, is repealed.
(b) Laws 2012, chapter 216, article 11, section 31, is repealed.