1.2relating to human services; modifying personal care assistance services;
1.3amending Minnesota Statutes 2010, sections 256B.0625, subdivision 19a;
1.4256B.0652, subdivision 6; Laws 2009, chapter 79, article 13, section 3,
1.5subdivision 8, as amended.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7    Section 1. Minnesota Statutes 2010, section 256B.0625, subdivision 19a, is amended to
1.8read:
1.9    Subd. 19a. Personal care assistance services. Medical assistance covers personal
1.10care assistance services in a recipient's home. Effective January 1, 2010, to qualify for
1.11personal care assistance services, a recipient must require assistance and be determined
1.12dependent in one activity of daily living as defined in section 256B.0659, subdivision 1,
1.13paragraph (b), or in a Level I behavior as defined in section 256B.0659, subdivision 1,
1.14paragraph (c). Beginning July 1, 2011, to qualify for personal care assistance services, a
1.15recipient must require assistance and be determined dependent in at least two activities
1.16of daily living as defined in section 256B.0659. Recipients or responsible parties must
1.17be able to identify the recipient's needs, direct and evaluate task accomplishment, and
1.18provide for health and safety. Approved hours may be used outside the home when normal
1.19life activities take them outside the home. To use personal care assistance services at
1.20school, the recipient or responsible party must provide written authorization in the care
1.21plan identifying the chosen provider and the daily amount of services to be used at school.
1.22Total hours for services, whether actually performed inside or outside the recipient's
1.23home, cannot exceed that which is otherwise allowed for personal care assistance services
1.24in an in-home setting according to sections 256B.0651 to 256B.0656. Medical assistance
1.25does not cover personal care assistance services for residents of a hospital, nursing facility,
2.1intermediate care facility, health care facility licensed by the commissioner of health, or
2.2unless a resident who is otherwise eligible is on leave from the facility and the facility
2.3either pays for the personal care assistance services or forgoes the facility per diem for the
2.4leave days that personal care assistance services are used. All personal care assistance
2.5services must be provided according to sections 256B.0651 to 256B.0656. Personal care
2.6assistance services may not be reimbursed if the personal care assistant is the spouse or
2.7paid guardian of the recipient or the parent of a recipient under age 18, or the responsible
2.8party or the family foster care provider of a recipient who cannot direct the recipient's own
2.9care unless, in the case of a foster care provider, a county or state case manager visits
2.10the recipient as needed, but not less than every six months, to monitor the health and
2.11safety of the recipient and to ensure the goals of the care plan are met. Notwithstanding
2.12the provisions of section 256B.0659, the unpaid guardian or conservator of an adult,
2.13who is not the responsible party and not the personal care provider organization, may be
2.14reimbursed to provide personal care assistance services to the recipient if the guardian or
2.15conservator meets all criteria for a personal care assistant according to section 256B.0659,
2.16and shall not be considered to have a service provider interest for purposes of participation
2.17on the screening team under section 256B.092, subdivision 7.

2.18    Sec. 2. Minnesota Statutes 2010, section 256B.0652, subdivision 6, is amended to read:
2.19    Subd. 6. Authorization; personal care assistance and qualified professional.
2.20    (a) All personal care assistance services, supervision by a qualified professional, and
2.21additional services beyond the limits established in subdivision 11, must be authorized
2.22by the commissioner or the commissioner's designee before services begin except for the
2.23assessments established in subdivision 11 and section 256B.0911. The authorization for
2.24personal care assistance and qualified professional services under section 256B.0659 must
2.25be completed within 30 days after receiving a complete request.
2.26    (b) The amount of personal care assistance services authorized must be based
2.27on the recipient's home care rating. The home care rating shall be determined by the
2.28commissioner or the commissioner's designee based on information submitted to the
2.29commissioner identifying the following for recipients with dependencies in two or more
2.30activities of daily living:
2.31    (1) total number of dependencies of activities of daily living as defined in section
2.32256B.0659 ;
2.33    (2) presence of complex health-related needs as defined in section 256B.0659; and
2.34    (3) presence of Level I behavior as defined in section 256B.0659.
3.1    (c) For persons meeting the criteria in paragraph (b), the methodology to determine
3.2total time for personal care assistance services for each home care rating is based on
3.3the median paid units per day for each home care rating from fiscal year 2007 data for
3.4the personal care assistance program. Each home care rating has a base level of hours
3.5assigned. Additional time is added through the assessment and identification of the
3.6following:
3.7    (1) 30 additional minutes per day for a dependency in each critical activity of daily
3.8living as defined in section 256B.0659;
3.9    (2) 30 additional minutes per day for each complex health-related function as
3.10defined in section 256B.0659; and
3.11    (3) 30 additional minutes per day for each behavior issue as defined in section
3.12256B.0659 , subdivision 4, paragraph (d).
3.13    (d) Effective July 1, 2011, the home care rating for recipients who have a dependency
3.14in one activity of daily living or level one behavior shall equal no more than two units per
3.15day. Recipients with this home care rating are not subject to the methodology in paragraph
3.16(c), and are not eligible for more than two units per day.
3.17(e) A limit of 96 units of qualified professional supervision may be authorized for
3.18each recipient receiving personal care assistance services. A request to the commissioner
3.19to exceed this total in a calendar year must be requested by the personal care provider
3.20agency on a form approved by the commissioner.

3.21    Sec. 3. Laws 2009, chapter 79, article 13, section 3, subdivision 8, as amended by
3.22Laws 2009, chapter 173, article 2, section 1, subdivision 8, Laws 2010, First Special
3.23Session chapter 1, article 15, section 5, and Laws 2010, First Special Session chapter 1,
3.24article 25, section 16, is amended to read:

3.25

Subd. 8.Continuing Care Grants

3.26The amounts that may be spent from the
3.27appropriation for each purpose are as follows:

3.28

(a) Aging and Adult Services Grants

13,499,000

15,805,000

3.29Base Adjustment. The general fund base is
3.30increased by $5,751,000 in fiscal year 2012
3.31and $6,705,000 in fiscal year 2013.
3.32Information and Assistance
3.33Reimbursement. Federal administrative
3.34reimbursement obtained from information
4.1and assistance services provided by the
4.2Senior LinkAge or Disability Linkage lines
4.3to people who are identified as eligible for
4.4medical assistance shall be appropriated to
4.5the commissioner for this activity.
4.6Community Service Development Grant
4.7Reduction. Funding for community service
4.8development grants must be reduced by
4.9$260,000 for fiscal year 2010; $284,000 in
4.10fiscal year 2011; $43,000 in fiscal year 2012;
4.11and $43,000 in fiscal year 2013. Base level
4.12funding shall be restored in fiscal year 2014.
4.13Community Service Development Grant
4.14Community Initiative. Funding for
4.15community service development grants shall
4.16be used to offset the cost of aging support
4.17grants. Base level funding shall be restored
4.18in fiscal year 2014.
4.19Senior Nutrition Use of Federal Funds.
4.20For fiscal year 2010, general fund grants
4.21for home-delivered meals and congregate
4.22dining shall be reduced by $500,000. The
4.23commissioner must replace these general
4.24fund reductions with equal amounts from
4.25federal funding for senior nutrition from the
4.26American Recovery and Reinvestment Act
4.27of 2009.

4.28

(b) Alternative Care Grants

50,234,000

48,576,000

4.29Base Adjustment. The general fund base is
4.30decreased by $3,598,000 in fiscal year 2012
4.31and $3,470,000 in fiscal year 2013.
4.32Alternative Care Transfer. Any money
4.33allocated to the alternative care program that
4.34is not spent for the purposes indicated does
5.1not cancel but must be transferred to the
5.2medical assistance account.

5.3 5.4

(c) Medical Assistance Grants; Long-Term Care Facilities.

367,444,000

419,749,000

5.5 5.6

(d) Medical Assistance Long-Term Care Waivers and Home Care Grants

853,567,000

1,039,517,000

5.7Manage Growth in TBI and CADI
5.8Waivers. During the fiscal years beginning
5.9on July 1, 2009, and July 1, 2010, the
5.10commissioner shall allocate money for home
5.11and community-based waiver programs
5.12under Minnesota Statutes, section 256B.49,
5.13to ensure a reduction in state spending that is
5.14equivalent to limiting the caseload growth of
5.15the TBI waiver to 12.5 allocations per month
5.16each year of the biennium and the CADI
5.17waiver to 95 allocations per month each year
5.18of the biennium. Limits do not apply: (1)
5.19when there is an approved plan for nursing
5.20facility bed closures for individuals under
5.21age 65 who require relocation due to the
5.22bed closure; (2) to fiscal year 2009 waiver
5.23allocations delayed due to unallotment; or (3)
5.24to transfers authorized by the commissioner
5.25from the personal care assistance program
5.26of individuals having a home care rating
5.27of "CS," "MT," or "HL." Priorities for the
5.28allocation of funds must be for individuals
5.29anticipated to be discharged from institutional
5.30settings or who are at imminent risk of a
5.31placement in an institutional setting.
5.32Manage Growth in DD Waiver. The
5.33commissioner shall manage the growth in
5.34the DD waiver by limiting the allocations
5.35included in the February 2009 forecast to 15
5.36additional diversion allocations each month
6.1for the calendar years that begin on January
6.21, 2010, and January 1, 2011. Additional
6.3allocations must be made available for
6.4transfers authorized by the commissioner
6.5from the personal care program of individuals
6.6having a home care rating of "CS," "MT,"
6.7or "HL."
6.8Adjustment to Lead Agency Waiver
6.9Allocations. Prior to the availability of the
6.10alternative license defined in Minnesota
6.11Statutes, section 245A.11, subdivision 8,
6.12the commissioner shall reduce lead agency
6.13waiver allocations for the purposes of
6.14implementing a moratorium on corporate
6.15foster care.
6.16Alternatives to Personal Care Assistance
6.17Services. Base level funding of $3,237,000
6.18in fiscal year 2012 and $4,856,000 in
6.19fiscal year 2013 is to implement alternative
6.20services to personal care assistance services
6.21for persons with mental health and other
6.22behavioral challenges who can benefit
6.23from other services that more appropriately
6.24meet their needs and assist them in living
6.25independently in the community. These
6.26services may include, but not be limited to, a
6.271915(i) state plan option.

6.28

(e) Mental Health Grants

6.29	Appropriations by Fund
6.30	General	77,739,000	77,739,000
6.31	Health Care Access	750,000	750,000
6.32	Lottery Prize	1,508,000	1,508,000

6.33Funding Usage. Up to 75 percent of a fiscal
6.34year's appropriation for adult mental health
6.35grants may be used to fund allocations in that
7.1portion of the fiscal year ending December
7.231.

7.3

(f) Deaf and Hard-of-Hearing Grants

1,930,000

1,917,000

7.4

(g) Chemical Dependency Entitlement Grants

111,303,000

122,822,000

7.5Payments for Substance Abuse Treatment.
7.6For placements beginning during fiscal years
7.72010 and 2011, county-negotiated rates and
7.8provider claims to the consolidated chemical
7.9dependency fund must not exceed the lesser
7.10of:
7.11(1) rates charged for these services on
7.12January 1, 2009; and or
7.13(2) 160 percent of the average rate on January
7.141, 2009, for each group of vendors with
7.15similar attributes.
7.16Rates for fiscal years 2010 and 2011 must
7.17not exceed 160 percent of the average rate on
7.18January 1, 2009, for each group of vendors
7.19with similar attributes.
7.20Effective July 1, 2010, rates that were above
7.21the average rate on January 1, 2009, are
7.22reduced by five percent from the rates in
7.23effect on June 1, 2010. Rates below the
7.24average rate on January 1, 2009, are reduced
7.25by 1.8 percent from the rates in effect on
7.26June 1, 2010. Services provided under
7.27this section by state-operated services are
7.28exempt from the rate reduction. For services
7.29provided in fiscal years 2012 and 2013, the
7.30statewide aggregate payment under the new
7.31rate methodology to be developed under
7.32Minnesota Statutes, section 254B.12, must
7.33not exceed the projected aggregate payment
7.34under the rates in effect for fiscal year 2011
8.1excluding the rate reduction for rates that
8.2were below the average on January 1, 2009,
8.3plus a state share increase of $3,787,000 for
8.4fiscal year 2012 and $5,023,000 for fiscal
8.5year 2013. Notwithstanding any provision
8.6to the contrary in this article, this provision
8.7expires on June 30, 2013.
8.8Chemical Dependency Special Revenue
8.9Account. For fiscal year 2010, $750,000
8.10must be transferred from the consolidated
8.11chemical dependency treatment fund
8.12administrative account and deposited into the
8.13general fund.
8.14County CD Share of MA Costs for
8.15ARRA Compliance. Notwithstanding the
8.16provisions of Minnesota Statutes, chapter
8.17254B, for chemical dependency services
8.18provided during the period October 1, 2008,
8.19to December 31, 2010, and reimbursed by
8.20medical assistance at the enhanced federal
8.21matching rate provided under the American
8.22Recovery and Reinvestment Act of 2009, the
8.23county share is 30 percent of the nonfederal
8.24share. This provision is effective the day
8.25following final enactment.

8.26 8.27

(h) Chemical Dependency Nonentitlement Grants

1,729,000

1,729,000

8.28

(i) Other Continuing Care Grants

19,201,000

17,528,000

8.29Base Adjustment. The general fund base is
8.30increased by $2,639,000 in fiscal year 2012
8.31and increased by $3,854,000 in fiscal year
8.322013.
8.33Technology Grants. $650,000 in fiscal
8.34year 2010 and $1,000,000 in fiscal year
8.352011 are for technology grants, case
9.1consultation, evaluation, and consumer
9.2information grants related to developing and
9.3supporting alternatives to shift-staff foster
9.4care residential service models.
9.5Other Continuing Care Grants; HIV
9.6Grants. Money appropriated for the HIV
9.7drug and insurance grant program in fiscal
9.8year 2010 may be used in either year of the
9.9biennium.
9.10Quality Assurance Commission. Effective
9.11July 1, 2009, state funding for the quality
9.12assurance commission under Minnesota
9.13Statutes, section 256B.0951, is canceled.