HF 1760

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:54am

A bill for an act
relating to human services; amending continuing care provisions, including
changes to medical assistance, nursing facilities, and data management; amending
Minnesota Statutes 2008, sections 252.282, subdivisions 3, 5; 256B.0657,
subdivisions 5, 8; 256B.0913, subdivisions 4, 5a, 12; 256B.0915, subdivision
2; 256B.431, subdivision 10; 256B.433, subdivision 1; 256B.438, subdivision
7; 256B.441, subdivisions 5, 11; 256B.5011, subdivision 2; 256B.5012,
subdivisions 6, 7; 256B.5013, subdivisions 1, 6; 626.557, subdivision 12b;
repealing Minnesota Statutes 2008, section 256B.5013, subdivisions 2, 3, 5.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2008, section 252.282, subdivision 3, is amended to read:

Subd. 3.

Recommendations.

(a) Upon completion of the local system needs
planning assessment, the host county shall make recommendations by May 15, 2000, and
by July 1 every two years thereafter beginning in 2001. If no change is recommended, a
copy of the assessment along with corresponding documentation shall be provided to the
commissioner by July 1 prior to the contract year.

deleted text begin (b) Except as provided in section 252.292, subdivision 4, recommendations
regarding closures, relocations, or downsizings that include a rate increase shall be
submitted to the statewide advisory committee for review, along with the assessment, plan,
and corresponding documentation that supports the payment rate adjustment request.
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Recommendations for closures, relocations, and downsizings that do not
include a rate increase and for modification of existing services for which a change in the
framework of service delivery is necessary shall be provided to the commissioner by July
1 prior to the contract year or at least 90 days prior to the anticipated change, along with
the assessment and corresponding documentation.

Sec. 2.

Minnesota Statutes 2008, section 252.282, subdivision 5, is amended to read:

Subd. 5.

Responsibilities of commissioner.

(a) In collaboration with counties and
providers, the commissioner shall ensure that services recognize the preferences and needs
of persons with developmental disabilities and related conditions through a recurring
systemic review and assessment of ICF/MR facilities within the state.

deleted text begin (b) The commissioner shall publish a notice in the State Register no less than
biannually to announce the opportunity for counties or providers to submit requests for
payment rate adjustments associated with plans for downsizing, relocation, and closure of
ICF/MR facilities.
deleted text end

deleted text begin (c) The commissioner shall designate funding parameters to counties and to the
statewide advisory committee for the overall implementation of system needs within the
fiscal resources allocated by the legislature.
deleted text end

deleted text begin (d) deleted text end new text begin (b) new text end The commissioner shall contract with ICF/MR providers. Contracts shall
be for two-year periods.

Sec. 3.

Minnesota Statutes 2008, section 256B.0657, subdivision 5, is amended to read:

Subd. 5.

Self-directed supports option plan requirements.

(a) The plan for the
self-directed supports option must meet the following requirements:

(1) the plan must be completed using a person-centered process that:

(i) builds upon the recipient's capacity to engage in activities that promote
community life;

(ii) respects the recipient's preferences, choices, and abilities;

(iii) involves families, friends, and professionals in the planning or delivery of
services or supports as desired or required by the recipient; and

(iv) addresses the need for personal care assistant services identified in the recipient's
self-directed supports option assessment;

(2) the plan shall be developed by the recipient or by the guardian of an adult
recipient or by a parent or guardian of a minor child, deleted text begin with the assistance of an enrolled
medical assistance home care targeted case manager deleted text end new text begin and may be assisted by a new text end provider
who meets the requirements established for using a person-centered planning process and
shall be reviewed at least annually upon reassessment or when there is a significant change
in the recipient's condition; and

(3) the plan must include the total budget amount available divided into monthly
amounts that cover the number of months of personal care assistant services authorization
included in the budget. The amount used each month may vary, but additional funds shall
not be provided above the annual personal care assistant services authorized amount
unless a change in condition is documented.

(b) The commissioner shall:

(1) establish the format and criteria for the plan as well as the requirements for
providers who assist with plan development;

(2) review the assessment and plan and, within 30 days after receiving the
assessment and plan, make a decision on approval of the plan;

(3) notify the recipient, parent, or guardian of approval or denial of the plan and
provide notice of the right to appeal under section 256.045; and

(4) provide a copy of the plan to the fiscal support entity selected by the recipient.

Sec. 4.

Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to read:

Subd. 8.

Self-directed budget requirements.

The budget for the provision of the
self-directed service option shall be equal to the greater of either:

(1) the annual amount of personal care assistant services under section 256B.0655
that the recipient has used in the most recent 12-month period; or

(2) deleted text begin the amount determined using the consumer support grant methodology under
section 256.476, subdivision 11, except that the budget amount shall include the federal
and nonfederal share of the average service costs deleted text end new text begin a budget allocation that is objective and
evidence-based utilizing valid, reliable cost data new text end .

Sec. 5.

Minnesota Statutes 2008, section 256B.0913, subdivision 4, is amended to read:

Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

(a) Funding for services under the alternative care program is available to persons who
meet the following criteria:

(1) the person has been determined by a community assessment under section
256B.0911 to be a person who would require the level of care provided in a nursing
facility, but for the provision of services under the alternative care program;

(2) the person is age 65 or older;

(3) the person would be eligible for medical assistance within 135 days of admission
to a nursing facility;

(4) the person is not ineligible for the payment of long-term care services by the
medical assistance program due to an asset transfer penalty under section 256B.0595 or
equity interest in the home exceeding $500,000 as stated in section 256B.056;

(5) the person needs long-term care services that are not funded through other
state or federal funding new text begin , or other health insurance or other third-party insurance such as
long-term care insurance new text end ;

(6) the monthly cost of the alternative care services funded by the program for
this person does not exceed 75 percent of the monthly limit described under section
256B.0915, subdivision 3a. This monthly limit does not prohibit the alternative care
client from payment for additional services, but in no case may the cost of additional
services purchased under this section exceed the difference between the client's monthly
service limit defined under section 256B.0915, subdivision 3, and the alternative care
program monthly service limit defined in this paragraph. If care-related supplies and
equipment or environmental modifications and adaptations are or will be purchased for
an alternative care services recipient, the costs may be prorated on a monthly basis for
up to 12 consecutive months beginning with the month of purchase. If the monthly cost
of a recipient's other alternative care services exceeds the monthly limit established in
this paragraph, the annual cost of the alternative care services shall be determined. In this
event, the annual cost of alternative care services shall not exceed 12 times the monthly
limit described in this paragraph; and

(7) the person is making timely payments of the assessed monthly fee.

A person is ineligible if payment of the fee is over 60 days past due, unless the person
agrees to:

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

(iii) the establishment of greater family involvement in the financial management of
payments; or

(iv) another method acceptable to the lead agency to ensure prompt fee payments.

The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.

(b) Alternative care funding under this subdivision is not available for a person
who is a medical assistance recipient or who would be eligible for medical assistance
without a spenddown or waiver obligation. A person whose initial application for medical
assistance and the elderly waiver program is being processed may be served under the
alternative care program for a period up to 60 days. If the individual is found to be eligible
for medical assistance, medical assistance must be billed for services payable under the
federally approved elderly waiver plan and delivered from the date the individual was
found eligible for the federally approved elderly waiver plan. Notwithstanding this
provision, alternative care funds may not be used to pay for any service the cost of which:
(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation;
or (iii) is used to pay a medical assistance income spenddown for a person who is eligible
to participate in the federally approved elderly waiver program under the special income
standard provision.

(c) Alternative care funding is not available for a person who resides in a licensed
nursing home, certified boarding care home, hospital, or intermediate care facility, except
for case management services which are provided in support of the discharge planning
process for a nursing home resident or certified boarding care home resident to assist with
a relocation process to a community-based setting.

(d) Alternative care funding is not available for a person whose income is greater
than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
year for which alternative care eligibility is determined, who would be eligible for the
elderly waiver with a waiver obligation.

Sec. 6.

Minnesota Statutes 2008, section 256B.0913, subdivision 5a, is amended to
read:

Subd. 5a.

Services; service definitions; service standards.

(a) Unless specified in
statute, the services, service definitions, and standards for alternative care services shall
be the same as the services, service definitions, and standards specified in the federally
approved elderly waiver plan, except alternative care does not cover transitional support
services, assisted living services, adult foster care services, and residential care and
benefits defined under section 256B.0625 that meet primary and acute health care needs.

(b) The lead agency must ensure that the funds are not used to supplant or
supplement services available through other public assistance or services programs,
including supplementation of client co-pays, deductibles, premiums, or other cost-sharing
arrangements for health-related benefits and services or entitlement programs and
services that are available to the person, but in which they have elected not to enroll.
new text begin The lead agency must ensure that the benefit department recovery system in the Medicaid
Management Information System (MMIS) has the necessary information on any other
health insurance or third-party insurance policy to which the client may have access. new text end For a
provider of supplies and equipment when the monthly cost of the supplies and equipment
is less than $250, persons or agencies must be employed by or under a contract with the
lead agency or the public health nursing agency of the local board of health in order to
receive funding under the alternative care program. Supplies and equipment may be
purchased from a vendor not certified to participate in the Medicaid program if the cost for
the item is less than that of a Medicaid vendor.

(c) Personal care services must meet the service standards defined in the federally
approved elderly waiver plan, except that a lead agency may contract with a client's
relative who meets the relative hardship waiver requirements or a relative who meets the
criteria and is also the responsible party under an individual service plan that ensures the
client's health and safety and supervision of the personal care services by a qualified
professional as defined in section 256B.0625, subdivision 19c. Relative hardship is
established by the lead agency when the client's care causes a relative caregiver to do any
of the following: resign from a paying job, reduce work hours resulting in lost wages,
obtain a leave of absence resulting in lost wages, incur substantial client-related expenses,
provide services to address authorized, unstaffed direct care time, or meet special needs of
the client unmet in the formal service plan.

Sec. 7.

Minnesota Statutes 2008, section 256B.0913, subdivision 12, is amended to
read:

Subd. 12.

Client fees.

(a) A fee is required for all alternative care eligible clients
to help pay for the cost of participating in the program. The amount of the fee for the
alternative care client shall be determined as follows:

(1) when the alternative care client's income less recurring and predictable medical
expenses is less than 100 percent of the federal poverty guideline effective on July 1 of
the state fiscal year in which the fee is being computed, and total assets are less than
$10,000, the fee is zero;

(2) when the alternative care client's income less recurring and predictable medical
expenses is equal to or greater than 100 percent but less than 150 percent of the federal
poverty guideline effective on July 1 of the state fiscal year in which the fee is being
computed, and total assets are less than $10,000, the fee is five percent of the cost of
alternative care services;

(3) when the alternative care client's income less recurring and predictable medical
expenses is equal to or greater than 150 percent but less than 200 percent of the federal
poverty guidelines effective on July 1 of the state fiscal year in which the fee is being
computed and assets are less than $10,000, the fee is 15 percent of the cost of alternative
care services;

(4) when the alternative care client's income less recurring and predictable medical
expenses is equal to or greater than 200 percent of the federal poverty guidelines effective
on July 1 of the state fiscal year in which the fee is being computed and assets are less than
$10,000, the fee is 30 percent of the cost of alternative care services; and

(5) when the alternative care client's assets are equal to or greater than $10,000, the
fee is 30 percent of the cost of alternative care services.

For married persons, total assets are defined as the total marital assets less the
estimated community spouse asset allowance, under section 256B.059, if applicable. For
married persons, total income is defined as the client's income less the monthly spousal
allotment, under section 256B.058.

All alternative care services shall be included in the estimated costs for the purpose
of determining the fee.

Fees are due and payable each month alternative care services are received unless the
actual cost of the services is less than the fee, in which case the fee is the lesser amount.

(b) The fee shall be waived by the commissioner when:

(1) a person is residing in a nursing facility;

(2) a married couple is requesting an asset assessment under the spousal
impoverishment provisions;

(3) a person is found eligible for alternative care, but is not yet receiving alternative
care services including case management services; or

(4) a person has chosen to participate in a consumer-directed service plan for which
the cost is no greater than the total cost of the person's alternative care service plan less
the monthly fee amount that would otherwise be assessed.

(c) The commissioner will bill and collect the fee from the client. Money collected
must be deposited in the general fund and is appropriated to the commissioner for the
alternative care program. The client must supply the lead agency with the client's Social
Security number at the time of application. The lead agency shall supply the commissioner
with the client's Social Security number and other information the commissioner requires
to collect the fee from the client. The commissioner shall collect unpaid fees using the
Revenue Recapture Act in chapter 270A and other methods available to the commissioner.
The commissioner may require lead agencies to inform clients of the collection procedures
that may be used by the state if a fee is not paid. deleted text begin This paragraph does not apply to
alternative care pilot projects authorized in Laws 1993, First Special Session chapter 1,
article 5, section 133, if a county operating under the pilot project reports the following
dollar amounts to the commissioner quarterly:
deleted text end

deleted text begin (1) total fees billed to clients;
deleted text end

deleted text begin (2) total collections of fees billed; and
deleted text end

deleted text begin (3) balance of fees owed by clients.
deleted text end

deleted text begin If a lead agency does not adhere to these reporting requirements, the commissioner may
terminate the billing, collecting, and remitting portions of the pilot project and require the
lead agency involved to operate under the procedures set forth in this paragraph.
deleted text end

Sec. 8.

Minnesota Statutes 2008, section 256B.0915, subdivision 2, is amended to read:

Subd. 2.

Spousal impoverishment policies.

The commissioner shall apply:

deleted text begin (1) deleted text end the spousal impoverishment criteria as authorized under United States Code, title
42, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059 deleted text begin ; deleted text end new text begin ,
except that individuals with income at or below the special income standard according
to Code of Federal Regulations, title 42, section 435.236, receive the maintenance needs
amount in subdivision 1d.
new text end

deleted text begin (2) the personal needs allowance permitted in section 256B.0575; and
deleted text end

deleted text begin (3) an amount equivalent to the group residential housing rate as set by section
256I.03, subdivision 5, and according to the approved federal waiver and medical
assistance state plan.
deleted text end

Sec. 9.

Minnesota Statutes 2008, section 256B.431, subdivision 10, is amended to read:

Subd. 10.

Property rate adjustments and construction projects.

deleted text begin A deleted text end Nursing
deleted text begin facility's deleted text end new text begin facilities completing a construction project that are eligible for a rate adjustment
under section 256B.434, subdivision 4f, that were not approved through the moratorium
exception process in section 144A.073 must new text end request deleted text begin for deleted text end new text begin from the commissioner new text end a
property-related payment rate adjustment deleted text begin and the related supporting documentation of
project construction cost information must be submitted to the commissioner deleted text end new text begin . If the
request is made new text end within 60 days after the construction project's completion date deleted text begin to be
considered eligible for a property-related payment rate adjustment deleted text end new text begin the effective date of
the rate adjustment is the first of the month following the completion date. If the request
is made more than 60 days after the completion date, the rate adjustment is effective on
the first of the month following the request new text end . The commissioner shall provide a rate notice
reflecting the allowable costs within 60 days after receiving all the necessary information
to compute the rate adjustment. No sooner than the effective date of the rate adjustment
for the deleted text begin building deleted text end new text begin construction new text end project, a nursing facility may adjust its rates by the amount
anticipated to be allowed. Any amounts collected from private pay residents in excess of
the allowable rate must be repaid to private pay residents with interest at the rate used by
the commissioner of revenue for the late payment of taxes and in effect on the date the
rate increase is effective. Construction projects with completion dates within one year
of the completion date associated with the property rate adjustment request and phased
projects with project completion dates within three years of the last phase of the phased
project must be aggregated for purposes of the minimum thresholds in subdivisions 16
and 17, and the maximum threshold in section 144A.071, subdivision 2. "Construction
project" and "project construction costs" have the meanings given them in Minnesota
Statutes, section 144A.071, subdivision 1a.

Sec. 10.

Minnesota Statutes 2008, section 256B.433, subdivision 1, is amended to read:

Subdivision 1.

Setting payment; monitoring use of therapy services.

The
commissioner shall deleted text begin promulgate deleted text end new text begin adopt new text end rules pursuant to the Administrative Procedure Act
to set the amount and method of payment for ancillary materials and services provided to
recipients residing in nursing facilities. Payment for materials and services may be made to
either deleted text begin the nursing facility in the operating cost per diem, to deleted text end the vendor of ancillary services
pursuant to Minnesota Rules, parts 9505.0170 to 9505.0475 or to a nursing facility
pursuant to Minnesota Rules, parts 9505.0170 to 9505.0475. Payment for the same or
similar service to a recipient shall not be made to both the nursing facility and the vendor.
The commissioner shall ensure the avoidance of double payments through audits and
adjustments to the nursing facility's annual cost report as required by section 256B.47, and
that charges and arrangements for ancillary materials and services are cost-effective and as
would be incurred by a prudent and cost-conscious buyer. Therapy services provided to
a recipient must be medically necessary and appropriate to the medical condition of the
recipient. If the vendor, nursing facility, or ordering physician cannot provide adequate
medical necessity justification, as determined by the commissioner, the commissioner may
recover or disallow the payment for the services and may require prior authorization for
therapy services as a condition of payment or may impose administrative sanctions to limit
the vendor, nursing facility, or ordering physician's participation in the medical assistance
program. If the provider number of a nursing facility is used to bill services provided by a
vendor of therapy services that is not related to the nursing facility by ownership, control,
affiliation, or employment status, no withholding of payment shall be imposed against the
nursing facility for services not medically necessary except for funds due the unrelated
vendor of therapy services as provided in subdivision 3, paragraph (c). For the purpose
of this subdivision, no monetary recovery may be imposed against the nursing facility
for funds paid to the unrelated vendor of therapy services as provided in subdivision 3,
paragraph (c), for services not medically necessary. For purposes of this section and
section 256B.47, therapy includes physical therapy, occupational therapy, speech therapy,
audiology, and mental health services that are covered services according to Minnesota
Rules, parts 9505.0170 to 9505.0475 deleted text begin , and that could be reimbursed separately from the
nursing facility per diem deleted text end . new text begin For purposes of this subdivision, "ancillary services" include
transportation defined as a covered service in section 256B.0625, subdivision 17. new text end

Sec. 11.

Minnesota Statutes 2008, section 256B.438, subdivision 7, is amended to read:

Subd. 7.

Rate determination upon transition to RUG-III payment rates.

(a) The
commissioner of human services shall determine payment rates at the time of transition to
the RUG based payment model in a facility-specific, budget-neutral manner. The case
mix indices as defined in subdivision 3 shall be used to allocate the case mix adjusted
component of total payment across all case mix groups. To transition from the current
calculation methodology to the RUG based methodology, the commissioner of health shall
report to the commissioner of human services the resident days classified according to the
categories defined in subdivision 3 for the 12-month reporting period ending September
30, 2001, for each nursing facility. The commissioner of human services shall use this
data to compute the standardized days for the reporting period under the RUG system.

(b) The commissioner of human services shall determine the case mix adjusted
component of the rate as follows:

(1) determine the case mix portion of the 11 case mix rates in effect on June 30,
2002, or the 34 case mix rates in effect on or after June 30, 2003;

(2) multiply each amount in clause (1) by the number of resident days assigned to
each group for the reporting period ending September 30, 2001, or the most recent year
for which data is available;

(3) compute the sum of the amounts in clause (2);

(4) determine the total RUG standardized days for the reporting period ending
September 30, 2001, or the most recent year for which data is available using the new
indices calculated under subdivision 3, paragraph (c);

(5) divide the amount in clause (3) by the amount in clause (4) which shall be the
average case mix adjusted component of the rate under the RUG method; and

(6) multiply this average rate by the case mix weight in subdivision 3 for each
RUG group.

new text begin (c) For the transition to MDS 3.0 and RUGs 4.0, scheduled to take place on October
1, 2009, or subsequent modification to the resident assessment or classification systems,
the commissioner shall determine the case mix adjusted component of the rate as follows:
new text end

new text begin (1) determine the case mix portion of the RUGs 3.0 operating payment rates in effect
on September 30, 2009, or most recent year;
new text end

new text begin (2) determine the number of resident days assigned to each group for the year ending
September 30, 2008, or most recent year;
new text end

new text begin (3) multiply the amounts in clause (1) by the resident days in clause (2) and compute
the sum of the amounts;
new text end

new text begin (4) adjust the values determined in clause (2) using data provided by CMS, including
the crosswalk and other statistical methods determined by the commissioner, to estimate
the distribution of the resident days under RUGs 4.0, and determine the estimated total
standardized days; and
new text end

new text begin (5) divide the amount in clause (3) by the amount in clause (4) which shall be the
case mix adjusted component of the operating payment rate under the RUGs 4.0 method
associated with a RUGs weight of 1.00, and multiply this average rate by the RUGs
4.0 indices published by CMS.
new text end

deleted text begin (c) deleted text end new text begin (d) new text end The noncase mix component will be allocated to each RUG group as a
constant amount to determine the transition payment rate. Any other rate adjustments that
are effective on or after July 1, 2002, shall be applied to the transition rates determined
under this section.

Sec. 12.

Minnesota Statutes 2008, section 256B.441, subdivision 5, is amended to read:

Subd. 5.

Administrative costs.

"Administrative costs" means the direct costs for
administering the overall activities of the nursing home. These costs include salaries and
wages of the administrator, assistant administrator, business office employees, security
guards, and associated fringe benefits and payroll taxes, fees, contracts, or purchases
related to business office functions, licenses, and permits except as provided in the external
fixed costs category, employee recognition, travel including meals and lodging, new text begin all new text end training new text begin
except as specified in subdivision 11 new text end , voice and data communication or transmission,
office supplies, liability insurance and other forms of insurance not designated to other
areas, personnel recruitment, legal services, accounting services, management or business
consultants, data processing, information technology, Web site, central or home office
costs, business meetings and seminars, postage, fees for professional organizations,
subscriptions, security services, advertising, board of director's fees, working capital
interest expense, and bad debts and bad debt collection fees.

Sec. 13.

Minnesota Statutes 2008, section 256B.441, subdivision 11, is amended to
read:

Subd. 11.

Direct care costs.

"Direct care costs" means costs for the wages of
nursing administration, deleted text begin staff education, deleted text end direct care registered nurses, licensed practical
nurses, certified nursing assistants, trained medication aides, new text begin employees conducting
training in resident care topics new text end and associated fringe benefits and payroll taxes; services
from a supplemental nursing services agency; supplies that are stocked at nursing stations
or on the floor and distributed or used individually, including, but not limited to: alcohol,
applicators, cotton balls, incontinence pads, disposable ice bags, dressings, bandages,
water pitchers, tongue depressors, disposable gloves, enemas, enema equipment, soap,
medication cups, diapers, plastic waste bags, sanitary products, thermometers, hypodermic
needles and syringes, clinical reagents or similar diagnostic agents, drugs that are not paid
on a separate fee schedule by the medical assistance program or any other payer, and
technology related to the provision of nursing care to residents, such as electronic charting
systems new text begin ; costs of materials used for resident care training, and training courses outside of
the facility attended by direct care staff on resident care topics new text end .

Sec. 14.

Minnesota Statutes 2008, section 256B.5011, subdivision 2, is amended to
read:

Subd. 2.

Contract provisions.

(a) The service contract with each intermediate
care facility must include provisions for:

(1) modifying payments when significant changes occur in the needs of the
consumers;

deleted text begin (2) the establishment and use of a quality improvement plan. Using criteria and
options for performance measures developed by the commissioner, each intermediate care
facility must identify a minimum of one performance measure on which to focus its efforts
for quality improvement during the contract period;
deleted text end

deleted text begin (3) deleted text end new text begin (2) new text end appropriate and necessary statistical information required by the
commissioner;

deleted text begin (4) deleted text end new text begin (3) new text end annual aggregate facility financial information; and

deleted text begin (5) deleted text end new text begin (4) new text end additional requirements for intermediate care facilities not meeting the
standards set forth in the service contract.

(b) The commissioner of human services and the commissioner of health, in
consultation with representatives from counties, advocacy organizations, and the provider
community, shall review the consolidated standards under chapter 245B and the supervised
living facility rule under Minnesota Rules, chapter 4665, to determine what provisions
in Minnesota Rules, chapter 4665, may be waived by the commissioner of health for
intermediate care facilities in order to enable facilities to implement the performance
measures in their contract and provide quality services to residents without a duplication
of or increase in regulatory requirements.

Sec. 15.

Minnesota Statutes 2008, section 256B.5012, subdivision 6, is amended to
read:

Subd. 6.

ICF/MR rate increases October 1, 2005, and October 1, 2006.

(a) For
the rate periods beginning October 1, 2005, and October 1, 2006, the commissioner shall
make available to each facility reimbursed under this section an adjustment to the total
operating payment rate of 2.2553 percent.

(b) 75 percent of the money resulting from the rate adjustment under paragraph (a)
must be used to increase wages and benefits and pay associated costs for employees,
except for administrative and central office employees. 75 percent of the money received
by a facility as a result of the rate adjustment provided in paragraph (a) must be used only
for wage, benefit, and staff increases implemented on or after the effective date of the rate
increase each year, and must not be used for increases implemented prior to that date. The
wage adjustment eligible employees may receive may vary based on merit, seniority, or
other factors determined by the provider.

(c) For each facility, the commissioner shall make available an adjustment, based
on occupied beds, using the percentage specified in paragraph (a) multiplied by the total
payment rate, including variable rate but excluding the property-related payment rate, in
effect on the preceding day. The total payment rate shall include the adjustment provided
in section 256B.501, subdivision 12.

(d) A facility whose payment rates are governed by closure agreements deleted text begin , deleted text end new text begin or
new text end receivership agreements deleted text begin , or Minnesota Rules, part 9553.0075, deleted text end is not eligible for an
adjustment otherwise granted under this subdivision.

(e) A facility may apply for the portion of the payment rate adjustment provided
under paragraph (a) for employee wages and benefits and associated costs. The application
must be made to the commissioner and contain a plan by which the facility will distribute
the funds according to paragraph (b). For facilities in which the employees are represented
by an exclusive bargaining representative, an agreement negotiated and agreed to by the
employer and the exclusive bargaining representative constitutes the plan. A negotiated
agreement may constitute the plan only if the agreement is finalized after the date of
enactment of all rate increases for the rate year. The commissioner shall review the plan to
ensure that the payment rate adjustment per diem is used as provided in this subdivision.
To be eligible, a facility must submit its plan by March 31, 2006, and December 31,
2006, respectively. If a facility's plan is effective for its employees after the first day of
the applicable rate period that the funds are available, the payment rate adjustment per
diem is effective the same date as its plan.

(f) A copy of the approved distribution plan must be made available to all employees
by giving each employee a copy or by posting it in an area of the facility to which all
employees have access. If an employee does not receive the wage and benefit adjustment
described in the facility's approved plan and is unable to resolve the problem with the
facility's management or through the employee's union representative, the employee
may contact the commissioner at an address or telephone number provided by the
commissioner and included in the approved plan.

Sec. 16.

Minnesota Statutes 2008, section 256B.5012, subdivision 7, is amended to
read:

Subd. 7.

ICF/MR rate increases effective October 1, 2007, and October 1, 2008.

(a) For the rate year beginning October 1, 2007, the commissioner shall make available to
each facility reimbursed under this section operating payment rate adjustments equal to
2.0 percent of the operating payment rates in effect on September 30, 2007. For the rate
year beginning October 1, 2008, the commissioner shall make available to each facility
reimbursed under this section operating payment rate adjustments equal to 2.0 percent
of the operating payment rates in effect on September 30, 2008. For each facility, the
commissioner shall make available an adjustment, based on occupied beds, using the
percentage specified in this paragraph multiplied by the total payment rate, including the
variable rate but excluding the property-related payment rate, in effect on the preceding
day. The total payment rate shall include the adjustment provided in section 256B.501,
subdivision 12. A facility whose payment rates are governed by closure agreements deleted text begin , deleted text end
new text begin or new text end receivership agreements deleted text begin , or Minnesota Rules, part 9553.0075, deleted text end is not eligible for an
adjustment otherwise granted under this subdivision.

(b) Seventy-five percent of the money resulting from the rate adjustments under
paragraph (a) must be used for increases in compensation-related costs for employees
directly employed by the facility on or after the effective date of the rate adjustments,
except:

(1) the administrator;

(2) persons employed in the central office of a corporation that has an ownership
interest in the facility or exercises control over the facility; and

(3) persons paid by the facility under a management contract.

(c) Two-thirds of the money available under paragraph (b) must be used for wage
increases for all employees directly employed by the facility on or after the effective
date of the rate adjustments, except those listed in paragraph (b), clauses (1) to (3). The
wage adjustment that employees receive under this paragraph must be paid as an equal
hourly percentage wage increase for all eligible employees. All wage increases under this
paragraph must be effective on the same date. Only costs associated with the portion of
the equal hourly percentage wage increase that goes to all employees shall qualify under
this paragraph. Costs associated with wage increases in excess of the amount of the equal
hourly percentage wage increase provided to all employees shall be allowed only for
meeting the requirements in paragraph (b). This paragraph shall not apply to employees
covered by a collective bargaining agreement.

(d) The commissioner shall allow as compensation-related costs all costs for:

(1) wages and salaries;

(2) FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers'
compensation;

(3) the employer's share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, and pensions; and

(4) other benefits provided, subject to the approval of the commissioner.

(e) The portion of the rate adjustments under paragraph (a) that is not subject to the
requirements in paragraphs (b) and (c) shall be provided to facilities effective October
1 of each year.

(f) Facilities may apply for the portion of the rate adjustments under paragraph
(a) that is subject to the requirements in paragraphs (b) and (c). The application
must be submitted to the commissioner within six months of the effective date of the
rate adjustments, and the facility must provide additional information required by
the commissioner within nine months of the effective date of the rate adjustments.
The commissioner must respond to all applications within three weeks of receipt.
The commissioner may waive the deadlines in this paragraph under extraordinary
circumstances, to be determined at the sole discretion of the commissioner. The
application must contain:

(1) an estimate of the amounts of money that must be used as specified in paragraphs
(b) and (c);

(2) a detailed distribution plan specifying the allowable compensation-related and
wage increases the facility will implement to use the funds available in clause (1);

(3) a description of how the facility will notify eligible employees of the contents of
the approved application, which must provide for giving each eligible employee a copy of
the approved application, excluding the information required in clause (1), or posting a
copy of the approved application, excluding the information required in clause (1), for
a period of at least six weeks in an area of the facility to which all eligible employees
have access; and

(4) instructions for employees who believe they have not received the
compensation-related or wage increases specified in clause (2), as approved by the
commissioner, and which must include a mailing address, e-mail address, and the
telephone number that may be used by the employee to contact the commissioner or the
commissioner's representative.

(g) The commissioner shall ensure that cost increases in distribution plans under
paragraph (f), clause (2), that may be included in approved applications, comply with
requirements in clauses (1) to (4):

(1) costs to be incurred during the applicable rate year resulting from wage and
salary increases effective after October 1, 2006, and prior to the first day of the facility's
payroll period that includes October 1 of each year shall be allowed if they were not used
in the prior year's application and they meet the requirements of paragraphs (b) and (c);

(2) a portion of the costs resulting from tenure-related wage or salary increases
may be considered to be allowable wage increases, according to formulas that the
commissioner shall provide, where employee retention is above the average statewide
rate of retention of direct care employees;

(3) the annualized amount of increases in costs for the employer's share of health
and dental insurance, life insurance, disability insurance, and workers' compensation shall
be allowable compensation-related increases if they are effective on or after April 1 of
the year in which the rate adjustments are effective and prior to April 1 of the following
year; and

(4) for facilities in which employees are represented by an exclusive bargaining
representative, the commissioner shall approve the application only upon receipt of a letter
of acceptance of the distribution plan, as regards members of the bargaining unit, signed
by the exclusive bargaining agent and dated after May 25, 2007. Upon receipt of the letter
of acceptance, the commissioner shall deem all requirements of this section as having
been met in regard to the members of the bargaining unit.

(h) The commissioner shall review applications received under paragraph (f) and
shall provide the portion of the rate adjustments under paragraphs (b) and (c) if the
requirements of this subdivision have been met. The rate adjustments shall be effective
October 1 of each year. Notwithstanding paragraph (a), if the approved application
distributes less money than is available, the amount of the rate adjustment shall be reduced
so that the amount of money made available is equal to the amount to be distributed.

Sec. 17.

Minnesota Statutes 2008, section 256B.5013, subdivision 1, is amended to
read:

Subdivision 1.

Variable rate adjustments.

(a) For rate years beginning on or after
October 1, 2000, when there is a documented increase in the needs of a current ICF/MR
recipient, the county of financial responsibility may recommend a variable rate to enable
the facility to meet the individual's increased needs. Variable rate adjustments made under
this subdivision replace payments for persons with special needs under section 256B.501,
subdivision 8, and payments for persons with special needs for crisis intervention services
under section 256B.501, subdivision 8a. Effective July 1, 2003, facilities with a base rate
above the 50th percentile of the statewide average reimbursement rate for a Class A
facility or Class B facility, whichever matches the facility licensure, are not eligible for a
variable rate adjustment. Variable rate adjustments may not exceed a 12-month period,
except when approved for purposes established in paragraph (b), clause (1). Variable rate
adjustments approved solely on the basis of changes on a developmental disabilities
screening document will end June 30, 2002.

(b) A variable rate may be recommended by the county of financial responsibility
for increased needs in the following situations:

(1) a need for resources due to an individual's full or partial retirement from
participation in a day training and habilitation service when the individual: (i) has reached
the age of 65 or has a change in health condition that makes it difficult for the person
to participate in day training and habilitation services over an extended period of time
because it is medically contraindicated; and (ii) has expressed a desire for change through
the developmental disability screening process under section 256B.092;

(2) a need for additional resources for intensive short-term programming which is
necessary prior to an individual's discharge to a less restrictive, more integrated setting;

(3) a demonstrated medical need that significantly impacts the type or amount of
services needed by the individual; or

(4) a demonstrated behavioral need that significantly impacts the type or amount of
services needed by the individual.

(c) The county of financial responsibility must justify the purpose, the projected
length of time, and the additional funding needed for the facility to meet the needs of
the individual.

(d) The facility shall provide deleted text begin a quarterly deleted text end new text begin an annual new text end report to the county case manager
on the use of the variable rate funds and the status of the individual on whose behalf the
funds were approved. The county case manager will forward the facility's report with a
recommendation to the commissioner to approve or disapprove a continuation of the
variable rate.

(e) Funds made available through the variable rate process that are not used by
the facility to meet the needs of the individual for whom they were approved shall be
returned to the state.

Sec. 18.

Minnesota Statutes 2008, section 256B.5013, subdivision 6, is amended to
read:

Subd. 6.

Commissioner's responsibilities.

The commissioner shall:

(1) make a determination to approve, deny, or modify a request for a variable rate
adjustment within 30 days of the receipt of the completed application;

(2) notify the ICF/MR facility and county case manager of the duration and
conditions of variable rate adjustment approvals; new text begin and
new text end

(3) modify MMIS II service agreements to reimburse ICF/MR facilities for approved
variable rates deleted text begin ; deleted text end new text begin .
new text end

deleted text begin (4) provide notification of legislatively appropriated funding for facility closures,
downsizings, and relocations;
deleted text end

deleted text begin (5) assess the fiscal impacts of the proposals for closures, downsizings, and
relocations forwarded for consideration through the state advisory committee; and
deleted text end

deleted text begin (6) review the payment rate process on a biannual basis and make recommendations
to the legislature for necessary adjustments to the review and approval process.
deleted text end

Sec. 19.

Minnesota Statutes 2008, section 626.557, subdivision 12b, is amended to
read:

Subd. 12b.

Data management.

(a) In performing any of the duties of this section as
a lead agency, the county social service agency shall maintain appropriate records. Data
collected by the county social service agency under this section are welfare data under
section 13.46. Notwithstanding section 13.46, subdivision 1, paragraph (a), data under this
paragraph that are inactive investigative data on an individual who is a vendor of services
are private data on individuals, as defined in section 13.02. The identity of the reporter
may only be disclosed as provided in paragraph (c).

Data maintained by the common entry point are confidential data on individuals or
protected nonpublic data as defined in section 13.02. Notwithstanding section 138.163,
the common entry point shall deleted text begin destroy data deleted text end new text begin maintain data for at least a period of new text end three
calendar years after date of receipt.

(b) The commissioners of health and human services shall prepare an investigation
memorandum for each report alleging maltreatment investigated under this section.
County social service agencies must maintain private data on individuals but are not
required to prepare an investigation memorandum. During an investigation by the
commissioner of health or the commissioner of human services, data collected under this
section are confidential data on individuals or protected nonpublic data as defined in
section 13.02. Upon completion of the investigation, the data are classified as provided in
clauses (1) to (3) and paragraph (c).

(1) The investigation memorandum must contain the following data, which are
public:

(i) the name of the facility investigated;

(ii) a statement of the nature of the alleged maltreatment;

(iii) pertinent information obtained from medical or other records reviewed;

(iv) the identity of the investigator;

(v) a summary of the investigation's findings;

(vi) statement of whether the report was found to be substantiated, inconclusive,
false, or that no determination will be made;

(vii) a statement of any action taken by the facility;

(viii) a statement of any action taken by the lead agency; and

(ix) when a lead agency's determination has substantiated maltreatment, a statement
of whether an individual, individuals, or a facility were responsible for the substantiated
maltreatment, if known.

The investigation memorandum must be written in a manner which protects the
identity of the reporter and of the vulnerable adult and may not contain the names or, to
the extent possible, data on individuals or private data listed in clause (2).

(2) Data on individuals collected and maintained in the investigation memorandum
are private data, including:

(i) the name of the vulnerable adult;

(ii) the identity of the individual alleged to be the perpetrator;

(iii) the identity of the individual substantiated as the perpetrator; and

(iv) the identity of all individuals interviewed as part of the investigation.

(3) Other data on individuals maintained as part of an investigation under this section
are private data on individuals upon completion of the investigation.

(c) The subject of the report may compel disclosure of the name of the reporter only
with the consent of the reporter or upon a written finding by a court that the report was
false and there is evidence that the report was made in bad faith. This subdivision does
not alter disclosure responsibilities or obligations under the Rules of Criminal Procedure,
except that where the identity of the reporter is relevant to a criminal prosecution, the
district court shall do an in-camera review prior to determining whether to order disclosure
of the identity of the reporter.

(d) Notwithstanding section 138.163, data maintained under this section by the
commissioners of health and human services must be deleted text begin destroyed deleted text end new text begin maintained new text end under the
following schedule:

(1) data from reports determined to be false, deleted text begin two deleted text end new text begin maintained at least a period of three new text end
years after the finding was made;

(2) data from reports determined to be inconclusive, new text begin maintained at least a period
of new text end four years after the finding was made;

(3) data from reports determined to be substantiated, new text begin maintained at least a period of
new text end seven years after the finding was made; and

(4) data from reports which were not investigated by a lead agency and for which
there is no final disposition, deleted text begin two deleted text end new text begin maintained at least a period of three new text end years from the
date of the report.

(e) The commissioners of health and human services shall each annually report to
the legislature and the governor on the number and type of reports of alleged maltreatment
involving licensed facilities reported under this section, the number of those requiring
investigation under this section, and the resolution of those investigations. The report
shall identify:

(1) whether and where backlogs of cases result in a failure to conform with statutory
time frames;

(2) where adequate coverage requires additional appropriations and staffing; and

(3) any other trends that affect the safety of vulnerable adults.

(f) Each lead agency must have a record retention policy.

(g) Lead agencies, prosecuting authorities, and law enforcement agencies may
exchange not public data, as defined in section 13.02, if the agency or authority requesting
the data determines that the data are pertinent and necessary to the requesting agency in
initiating, furthering, or completing an investigation under this section. Data collected
under this section must be made available to prosecuting authorities and law enforcement
officials, local county agencies, and licensing agencies investigating the alleged
maltreatment under this section. The lead agency shall exchange not public data with the
vulnerable adult maltreatment review panel established in section 256.021 if the data are
pertinent and necessary for a review requested under that section. Upon completion of the
review, not public data received by the review panel must be returned to the lead agency.

(h) Each lead agency shall keep records of the length of time it takes to complete its
investigations.

(i) A lead agency may notify other affected parties and their authorized representative
if the agency has reason to believe maltreatment has occurred and determines the
information will safeguard the well-being of the affected parties or dispel widespread
rumor or unrest in the affected facility.

(j) Under any notification provision of this section, where federal law specifically
prohibits the disclosure of patient identifying information, a lead agency may not provide
any notice unless the vulnerable adult has consented to disclosure in a manner which
conforms to federal requirements.

Sec. 20. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 256B.5013, subdivisions 2, 3, and 5, new text end new text begin are repealed.
new text end