HF 767

1st Unofficial Engrossment - 88th Legislature (2013 - 2014) Posted on 05/08/2013 04:55pm

1.1A bill for an act

1.2relating to human services; making changes to continuing care provisions;
1.3modifying provisions related to advisory task forces, nursing homes, resident
1.4relocation, medical assistance, long-term care consultation services, assessments,
1.5and reporting of maltreatment; requiring a report;amending Minnesota Statutes
1.62012, sections 15.014, subdivision 2; 144.0724, subdivision 12; 144A.071,
1.7subdivision 4d; 144A.161; 256B.056, subdivision 3; 256B.057, subdivision 9;
1.8256B.0652, subdivision 5; 256B.0659, subdivision 7, by adding a subdivision;
1.9256B.0911, subdivision 3a; 256B.092, subdivision 7; 256B.441, subdivisions 1,
1.1043, 63; 256B.49, subdivision 14; 256B.492; 626.557, subdivision 10; repealing
1.11Minnesota Statutes 2012, section 256B.437, subdivision 8; Laws 2012, chapter
1.12216, article 11, section 31.
1.13BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.14    Section 1. Minnesota Statutes 2012, section 15.014, subdivision 2, is amended to read:
1.15    Subd. 2. Creation; limitations. A commissioner of a state department, a state board
1.16or other agency having the powers of a board as defined in section 15.012, may create
1.17advisory task forces to advise the commissioner or agency on specific programs or topics
1.18within the jurisdiction of the department or agency. A task force so created shall have
1.19no more than 15 members. The task force shall expire and the terms and removal of
1.20members shall be as provided in section 15.059, subdivision 6. The members of no more
1.21than four task forces created pursuant to this section in a department or agency may be
1.22paid expenses in the same manner and amount as authorized by the commissioner's plan
1.23adopted according to section 43A.18, subdivision 2. Task forces mandated by court order
1.24must not be counted for purposes of the limit on the number of task forces whose members
1.25may be paid expenses. No member of a task force shall be compensated for services in a
1.26manner not provided for in statute. A commissioner, board, council, committee, or other
1.27state agency may not create any other multimember agency unless specifically authorized
2.1by statute or unless the creation of the agency is authorized by federal law as a condition
2.2precedent to the receipt of federal money.

2.3    Sec. 2. Minnesota Statutes 2012, section 144.0724, subdivision 12, is amended to read:
2.4    Subd. 12. Appeal of nursing facility level of care determination. A resident or
2.5prospective resident whose level of care determination results in a denial of long-term
2.6care services can appeal the determination as outlined in section 256B.0911, subdivision
2.73a , paragraph (h), clause (7) (9).

2.8    Sec. 3. Minnesota Statutes 2012, section 144A.071, subdivision 4d, is amended to read:
2.9    Subd. 4d. Consolidation of nursing facilities. (a) The commissioner of health,
2.10in consultation with the commissioner of human services, may approve a request for
2.11consolidation of nursing facilities which includes the closure of one or more facilities
2.12and the upgrading of the physical plant of the remaining nursing facility or facilities,
2.13the costs of which exceed the threshold project limit under subdivision 2, clause (a).
2.14The commissioners shall consider the criteria in this section, section 144A.073, and
2.15section 256B.437, in approving or rejecting a consolidation proposal. In the event the
2.16commissioners approve the request, the commissioner of human services shall calculate a
2.17property rate adjustment according to clauses (1) to (3):
2.18(1) the closure of beds shall not be eligible for a planned closure rate adjustment
2.19under section 256B.437, subdivision 6;
2.20(2) the construction project permitted in this clause shall not be eligible for a
2.21threshold project rate adjustment under section 256B.434, subdivision 4f, or a moratorium
2.22exception adjustment under section 144A.073; and
2.23(3) the property payment rate for a remaining facility or facilities shall be increased
2.24by an amount equal to 65 percent of the projected net cost savings to the state calculated in
2.25paragraph (b), divided by the state's medical assistance percentage of medical assistance
2.26dollars, and then divided by estimated medical assistance resident days, as determined
2.27in paragraph (c), of the remaining nursing facility or facilities in the request in this
2.28paragraph. The rate adjustment is effective on the later of the first day of the month
2.29following completion of the construction upgrades in the consolidation plan or the first
2.30day of the month following the complete closure of a facility designated for closure in the
2.31consolidation plan. If more than one facility is receiving upgrades in the consolidation
2.32plan, each facility's date of construction completion must be evaluated separately.
2.33(b) For purposes of calculating the net cost savings to the state, the commissioner
2.34shall consider clauses (1) to (7):
3.1(1) the annual savings from estimated medical assistance payments from the net
3.2number of beds closed taking into consideration only beds that are in active service on the
3.3date of the request and that have been in active service for at least three years;
3.4(2) the estimated annual cost of increased case load of individuals receiving services
3.5under the elderly waiver;
3.6(3) the estimated annual cost of elderly waiver recipients receiving support under
3.7group residential housing;
3.8(4) the estimated annual cost of increased case load of individuals receiving services
3.9under the alternative care program;
3.10(5) the annual loss of license surcharge payments on closed beds;
3.11(6) the savings from not paying planned closure rate adjustments that the facilities
3.12would otherwise be eligible for under section 256B.437; and
3.13(7) the savings from not paying property payment rate adjustments from submission
3.14of renovation costs that would otherwise be eligible as threshold projects under section
3.15256B.434, subdivision 4f .
3.16(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
3.17assistance resident days of the remaining facility or facilities shall be computed assuming
3.1895 percent occupancy multiplied by the historical percentage of medical assistance
3.19resident days of the remaining facility or facilities, as reported on the facility's or facilities'
3.20most recent nursing facility statistical and cost report filed before the plan of closure
3.21is submitted, multiplied by 365.
3.22(d) For purposes of net cost of savings to the state in paragraph (b), the average
3.23occupancy percentages will be those reported on the facility's or facilities' most recent
3.24nursing facility statistical and cost report filed before the plan of closure is submitted, and
3.25the average payment rates shall be calculated based on the approved payment rates in
3.26effect at the time the consolidation request is submitted.
3.27(e) To qualify for the property payment rate adjustment under this provision, the
3.28closing facilities shall:
3.29(1) submit an application for closure according to section 256B.437, subdivision
3.303; and
3.31(2) follow the resident relocation provisions of section 144A.161.
3.32(f) The county or counties in which a facility or facilities are closed under this
3.33subdivision shall not be eligible for designation as a hardship area under section 144A.071,
3.34subdivision 3, for five years from the date of the approval of the proposed consolidation.
3.35The applicant shall notify the county of this limitation and the county shall acknowledge
3.36this in a letter of support.

4.1    Sec. 4. Minnesota Statutes 2012, section 144A.161, is amended to read:
4.2144A.161 NURSING HOME AND BOARDING CARE HOME RESIDENT
4.3RELOCATION.
4.4    Subdivision 1. Definitions. The definitions in this subdivision apply to subdivisions
4.52 to 10.
4.6(a) "Change in operations" means any alteration in operations which would require
4.7or encourage the relocation of residents.
4.8(b) "Closure" or "closing" means the cessation of operations of a facility and the
4.9delicensure and decertification of all beds within the facility.
4.10(b) "Curtailment," "reduction," or "Change" refers to any change in operations which
4.11would result in or encourage the relocation of residents.
4.12(c) "Facility" means a nursing home licensed pursuant to this chapter, or a certified
4.13boarding care home licensed pursuant to sections 144.50 to 144.56. "Contact information"
4.14means name, address, and telephone number and, when available, e-mail address and
4.15facsimile number.
4.16(d) "Licensee" means the owner of the facility or the owner's designee or the
4.17commissioner of health for a facility in receivership.
4.18(e) (d) "County social services agency" means the county or multicounty social
4.19service agency authorized under sections 393.01 and 393.07, as the agency responsible for
4.20providing social services for the county in which the nursing home facility is located.
4.21(e) "Facility" means a nursing home licensed pursuant to this chapter, or a boarding
4.22care home licensed pursuant to sections 144.50 to 144.56.
4.23(f) "Licensee" means the owner of the facility or the owner's designee or the
4.24commissioner of health for a facility in receivership.
4.25(f) (g) "Plan" or "relocation plan" means a description of the process developed
4.26under subdivision 3, paragraph (b), for the relocation of residents in cases of a facility
4.27 closure, curtailment, reduction, or change in operations in a facility and the subsequent
4.28relocation of residents.
4.29(h) "Reduction" means a decrease in the number of beds that would require or
4.30encourage the relocation of residents.
4.31(g) (i) "Relocation" means the discharge of a resident and movement of the resident
4.32to another facility or living arrangement as a result of the closing, curtailment, reduction,
4.33or change in operations of a nursing home or boarding care home facility.
4.34(j) "Responsible party" means an individual acting as a legal representative for the
4.35resident.
5.1    Subd. 1a. Scope. Where a facility is undertaking a closure, curtailment, reduction,
5.2or change in operations, or where a housing with services unit registered under chapter
5.3144D is closed because the space that it occupies is being replaced by a nursing facility
5.4bed that is being reactivated from layaway status, the facility and the county social
5.5services agency must comply with the requirements of this section.
5.6    Subd. 2. Initial notice from licensee. (a) A licensee shall notify the following
5.7parties in writing when there is an intent to close or curtail, reduce, or change operations
5.8which that would result in require or encourage the relocation of residents:
5.9(1) the commissioner of health;
5.10(2) the commissioner of human services;
5.11(3) the county social services agency;
5.12(4) the Office of Ombudsman for Long-Term Care; and
5.13(5) the Office of Ombudsman for Mental Health and Developmental Disabilities.; and
5.14(6) the managed care organizations contracting with Minnesota health care programs
5.15within the county where the nursing facility is located.
5.16(b) The written notice shall include the names, telephone numbers, facsimile
5.17numbers, and e-mail addresses contact information of the persons in the facility
5.18responsible for coordinating the licensee's efforts in the planning process, and the number
5.19of residents potentially affected by the closure or curtailment, reduction, or change in
5.20operations. Only the copy of the notice provided to the county social services agency shall
5.21include a complete resident census, including resident name, date of birth, Social Security
5.22number, and medical assistance identification number if it is available.
5.23(c) For a facility that is reducing or changing operations, after providing written
5.24notice under this section subdivision 5a, and prior to admission, the facility must fully
5.25inform prospective residents and their families responsible parties of the intent to close or
5.26curtail, reduce, or change operations, and of the relocation plan.
5.27(d) A closing facility is prohibited from admitting any new residents on or after the
5.28date of the written notice provided under subdivision 5a.
5.29    Subd. 3. Planning process. (a) The county social services agency shall, within
5.30five working days of receiving initial notice of the licensee's intent to close or curtail,
5.31reduce, or change operations, provide the licensee and all parties identified in subdivision
5.322, paragraph (a), with the names, telephone numbers, facsimile numbers, and e-mail
5.33addresses contact information of those persons responsible for coordinating county social
5.34services agency efforts in the planning process.
5.35(b) Within ten working days of receipt of the notice under subdivision 2, paragraph
5.36(a), the county social services agency and licensee shall meet to develop the relocation
6.1plan. The county social services agency shall inform the Departments Department of
6.2Health and the Department of Human Services, the Office of Ombudsman for Long-Term
6.3Care, and the Office of Ombudsman for Mental Health and Developmental Disabilities of
6.4the date, time, and location of the meeting so that their representatives may attend. The
6.5relocation plan must be completed within no later than 45 days of after receipt of the initial
6.6notice in subdivision 2, paragraph (a). However, the plan may be finalized on an earlier
6.7schedule agreed to by all parties. To the extent practicable, consistent with requirements
6.8to protect the safety and health of residents, the commissioner may authorize the planning
6.9process under this subdivision to occur concurrent with the 60-day notice required under
6.10subdivision 5a. The plan shall:
6.11(1) identify the expected date of closure, curtailment, reduction, or change in
6.12operations;
6.13(2) outline the process for public notification of the closure, curtailment, reduction,
6.14or change in operations;
6.15(3) identify efforts that will be made to include other stakeholders in the relocation
6.16process;
6.17(4) outline the process to ensure 60-day advance written notice to residents, family
6.18members, and designated representatives;
6.19(5) present an aggregate description of the resident population remaining to be
6.20relocated and the population's needs;
6.21(6) outline the individual resident assessment process to be utilized;
6.22(7) identify an inventory of available relocation options and resources, including
6.23home and community-based services;
6.24(8) identify a timeline for submission of the list identified in subdivision 5c,
6.25paragraph (b);
6.26(9) (8) identify a schedule for the timely completion of each element of the plan; and
6.27(10) (9) identify the steps the licensee and the county social services agency will
6.28take to address the relocation needs of individual residents who may be difficult to place
6.29due to specialized care needs such as behavioral health problems.; and
6.30(10) identify the steps needed to share information and coordinate relocation efforts
6.31with managed care organizations.
6.32(c) All parties to the plan shall refrain from any public notification of the intent to
6.33close or curtail, reduce, or change operations until a relocation plan has been established
6.34 and the notice in subdivision 5a is given. If the planning process occurs concurrently with
6.35the 60-day notice period, this requirement does not apply once 60-day notice is given.
7.1    Subd. 4. Responsibilities of licensee for resident relocations. The licensee shall
7.2provide for the safe, orderly, and appropriate relocation of residents. The licensee and
7.3facility staff shall cooperate with representatives from the county social services agency,
7.4the Department of Health, the Department of Human Services, the Office of Ombudsman
7.5for Long-Term Care, and the Office of Ombudsman for Mental Health and Developmental
7.6Disabilities in planning for and implementing the relocation of residents.
7.7    Subd. 5. Licensee responsibilities prior related to relocation sending the notice
7.8in subdivision 5a. (a) The licensee shall establish an interdisciplinary team responsible
7.9for coordinating and implementing the plan. The interdisciplinary team shall include
7.10representatives from the county social services agency, the Office of Ombudsman for
7.11Long-Term Care, the Office of the Ombudsman for Mental Health and Developmental
7.12Disabilities, facility staff that provide direct care services to the residents, and facility
7.13administration.
7.14(b) Concurrent with the notice provided in subdivision 5a, the licensee shall
7.15provide a an updated resident census summary document to the county social services
7.16agency, the Ombudsman for Long-Term Care, and the Ombudsman for Mental Health
7.17and Developmental Disabilities that includes the following information on each resident
7.18to be relocated:
7.19(1) resident name;
7.20(2) date of birth;
7.21(3) Social Security number;
7.22(4) payment source and medical assistance identification number, if applicable;
7.23(5) county of financial responsibility if the resident is enrolled in a Minnesota health
7.24care program;
7.25(6) date of admission to the facility;
7.26(7) all current diagnoses;
7.27(8) the name of and contact information for the resident's physician;
7.28(9) the name and contact information for the resident's family or other designated
7.29representative responsible party;
7.30(10) the names name of and contact information for any case managers manager,
7.31managed care coordinator, or other care coordinator, if known; and
7.32(11) information on the resident's status related to commitment and probation.; and
7.33(12) the name of the managed care organization in which the resident is enrolled,
7.34if known.
7.35(c) The licensee shall consult with the county social services agency on the
7.36availability and development of available resources and on the resident relocation process.
8.1    Subd. 5a. Administrator and licensee responsibilities responsibility to provide
8.2notice. At least 60 days before the proposed date of closing, curtailment, reduction, or
8.3change in operations as agreed to in the plan, the licensee administrator shall send a
8.4written notice of closure or curtailment, reduction, or change in operations to each resident
8.5being relocated, the resident's family member or designated representative responsible
8.6party, and the resident's managed care organization if it is known, the county social
8.7services agency, the commissioner of health, the commissioner of human services, the
8.8Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental
8.9Health and Developmental Disabilities, the resident's attending physician, and, in the case
8.10of a complete facility closure, the Centers for Medicare and Medicaid Services regional
8.11office designated representative. The notice must include the following:
8.12(1) the date of the proposed closure, curtailment, reduction, or change in operations;
8.13(2) the name, address, telephone number, facsimile number, and e-mail address
8.14 contact information of the individual or individuals in the facility responsible for providing
8.15assistance and information;
8.16(3) notification of upcoming meetings for residents, families and designated
8.17representatives responsible parties, and resident and family councils to discuss the plan
8.18for relocation of residents;
8.19(4) the name, address, and telephone number contact information of the county
8.20social services agency contact person; and
8.21(5) the name, address, and telephone number contact information of the Office of
8.22Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and
8.23Developmental Disabilities.
8.24The notice must comply with all applicable state and federal requirements for notice
8.25of transfer or discharge of nursing home residents.
8.26    Subd. 5b. Licensee responsibility regarding medical information. The licensee
8.27shall request the attending physician provide or arrange for the release of medical
8.28information needed to update resident medical records and prepare all required forms
8.29and discharge summaries.
8.30    Subd. 5c. Licensee responsibility regarding placement information. (a) The
8.31licensee shall provide sufficient preparation to residents each resident to ensure safe, and
8.32 orderly, and appropriate discharge and relocation. The licensee shall assist residents
8.33 each resident in finding placements that respond to personal preferences, such as desired
8.34geographic location take into consideration quality, services, location, the resident's needs
8.35and choices, and the best interests of each resident.
9.1(b) The licensee shall prepare a resource list with several relocation options for each
9.2resident. The list must contain the following information for each relocation option,
9.3when applicable:
9.4(1) the name, address, and telephone and facsimile numbers of each facility with
9.5appropriate, available beds or services;
9.6(2) the certification level of the available beds;
9.7(3) the types of services available; and
9.8(4) the name, address, and telephone and facsimile numbers of appropriate available
9.9home and community-based placements, services, and settings or other options for
9.10individuals with special needs.
9.11The list shall be made available to residents and their families or designated
9.12representatives, and upon request to the Office of Ombudsman for Long-Term Care, the
9.13Office of Ombudsman for Mental Health and Developmental Disabilities, and the county
9.14social services agency.
9.15(c) The Senior LinkAge line may make available via a Web site the name, address,
9.16and telephone and facsimile numbers of each facility with available beds, the certification
9.17level of the available beds, the types of services available, and the number of beds that are
9.18available as updated daily by the listed facilities. The licensee must provide residents,
9.19their families or designated representatives, the Office of Ombudsman for Long-Term
9.20Care, the Office of Ombudsman for Mental Health and Developmental Disabilities, and
9.21the county social services agency with the toll-free number and Web site address for
9.22the Senior LinkAge line.
9.23    Subd. 5d. Licensee responsibility to meet with residents and families responsible
9.24parties. Following the establishment of the plan, the licensee shall conduct meetings with
9.25residents, families and designated representatives responsible parties, and resident and
9.26family councils to notify them of the process for resident relocation. Representatives from
9.27the local county social services agency, the Office of Ombudsman for Long-Term Care,
9.28the Office of Ombudsman for Mental Health and Developmental Disabilities, managed
9.29care organizations with residents in the facility, the commissioner of health, and the
9.30commissioner of human services shall receive advance notice of the meetings.
9.31    Subd. 5e. Licensee responsibility for site visits. The licensee shall assist
9.32residents desiring to make site visits to facilities with available beds or other appropriate
9.33living options to which the resident may relocate, unless it is medically inadvisable, as
9.34documented by the attending physician in the resident's care record. The licensee shall
9.35provide or arrange make available to the resident at no charge transportation for up to
9.36three site visits to facilities or other living options within a 50-mile radius to which the
10.1resident may relocate, or within a larger radius if no suitable options are available within
10.250 miles. The licensee shall provide available written materials to residents on a potential
10.3new facility or living option the county or contiguous counties.
10.4    Subd. 5f. Licensee responsible responsibility for resident property, funds, and
10.5telephone service communication devices. (a) The licensee shall complete an inventory
10.6of resident personal possessions and provide a copy of the final inventory to the resident
10.7and the resident's designated representative responsible party prior to relocation. The
10.8licensee shall be responsible for the transfer of the resident's possessions for all relocations
10.9within a 50-mile radius of the facility, or within a larger radius if no suitable options are
10.10available within 50 miles to a selected new location within the county or contiguous
10.11counties. The licensee shall complete the transfer of resident possessions in a timely
10.12manner, but no later than the date of the actual physical relocation of the resident.
10.13(b) The licensee shall complete a final accounting of personal funds held in trust
10.14by the facility and provide a copy of this accounting to the resident and the resident's
10.15family or the resident's designated representative responsible party. The licensee shall be
10.16responsible for the transfer of all personal funds held in trust by the facility. The licensee
10.17shall complete the transfer of all personal funds in a timely manner.
10.18(c) The licensee shall assist residents with the transfer and reconnection of service
10.19for telephones or, for residents who are deaf or blind, other personal communication
10.20devices or services. The licensee shall pay the costs associated with reestablishing
10.21service for telephones or other personal communication devices or services, such as
10.22connection fees or other onetime charges. The transfer or and reconnection of personal
10.23communication devices or services shall be completed in a timely manner.
10.24    Subd. 5g. Licensee responsibilities for final written discharge notice and records
10.25transfer. (a) The licensee shall provide the resident, the resident's family or designated
10.26representative responsible parties, the resident's managed care organization, if known,
10.27and the resident's attending physician with a final written discharge notice prior to the
10.28relocation of the resident. The notice must:
10.29(1) be provided seven days prior to the actual relocation, unless the resident agrees
10.30to waive the right to advance notice; and
10.31(2) identify the effective date of the anticipated relocation and the destination to
10.32which the resident is being relocated.
10.33(b) The licensee shall provide the receiving facility or other health, housing, or care
10.34entity with complete and accurate resident records including contact information on for
10.35 family members, designated representatives responsible parties, guardians, social service
10.36or other caseworkers, or other contact information and managed care coordinators. These
11.1records must also include all information necessary to provide appropriate medical care
11.2and social services. This includes, but is not limited to, information on preadmission
11.3screening, Level I and Level II screening, minimum data set (MDS), and all other
11.4assessments, current resident diagnoses, social, behavioral, and medication information,
11.5required forms, and discharge summaries.
11.6(c) For residents with special care needs, the licensee shall consult with the receiving
11.7facility or other placement entity and provide staff training or other preparation as needed
11.8to assist in providing for the special needs.
11.9    Subd. 6. Responsibilities of licensee during relocation. (a) The licensee shall, at
11.10no charge to the resident, make arrangements or provide for the transportation of residents
11.11to the new facility or placement within a 50-mile radius, or within a larger radius if no
11.12suitable options are available within 50 miles location within the county or contiguous
11.13counties. The licensee shall provide a staff person to accompany the resident during
11.14transportation to the new location within the county or contiguous counties, upon request
11.15of the resident, the resident's family, or designated representative responsible party. The
11.16discharge and relocation of residents must comply with all applicable state and federal
11.17requirements and must be conducted in a safe, and orderly, and appropriate manner.
11.18The licensee must ensure that there is no disruption in providing meals, medications, or
11.19treatments of a resident during the relocation process.
11.20(b) Beginning the week following development of the initial relocation plan the
11.21announcement in subdivision 5a, the licensee shall submit weekly status reports to the
11.22commissioners commissioner of health and the commissioner of human services or their
11.23designees, the Ombudsman for Long-Term Care and Ombudsman for Mental Health
11.24and Developmental Disabilities, and to the county social services agency. The status
11.25reports must be submitted in the format required by the commissioner of health and the
11.26commissioner of human services. The initial status report must identify:
11.27(1) the relocation plan developed;
11.28(2) the interdisciplinary team members; and
11.29(3) the number of residents to be relocated.
11.30(c) Subsequent status reports must identify:
11.31(1) any modifications to the plan;
11.32(2) any change of interdisciplinary team members;
11.33(3) the number of residents relocated;
11.34(4) the destination to which residents have been relocated;
11.35(5) the number of residents remaining to be relocated; and
11.36(6) issues or problems encountered during the process and resolution of these issues.
12.1    Subd. 7. Responsibilities of licensee following relocation. The licensee shall retain
12.2or make arrangements for the retention of all remaining resident records for the period
12.3required by law. The licensee shall provide the Department of Health access to these
12.4records. The licensee shall notify the Department of Health of the location of any resident
12.5records that have not been transferred to the new facility or other health care entity.
12.6    Subd. 8. Responsibilities of county social services agency. (a) The county social
12.7services agency shall participate in the meeting as outlined in subdivision 3, paragraph
12.8(b), to develop a relocation plan.
12.9(b) The county social services agency shall designate a representative to the
12.10interdisciplinary team established by the licensee responsible for coordinating the
12.11relocation efforts.
12.12(c) The county social services agency shall serve as a resource in the relocation
12.13process.
12.14(d) Concurrent with the notice sent to residents from the licensee as provided in
12.15subdivision 5a, the county social services agency shall provide written notice to residents,
12.16family, or designated representatives and responsible parties describing:
12.17(1) the county's role in the relocation process and in the follow-up to relocations;
12.18(2) a the county social services agency contact name, address, and telephone number
12.19 information; and
12.20(3) the name, address, and telephone number of contact information for the Office
12.21of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health
12.22and Developmental Disabilities.
12.23(e) The county social services agency designee shall meet with appropriate facility
12.24staff to coordinate any assistance in the relocation process. This coordination shall include
12.25participating in group meetings with residents, families, and designated representatives
12.26 responsible parties to explain the relocation process.
12.27(f) Beginning from the initial notice given in subdivision 2, the county social services
12.28agency shall monitor compliance with all components of this section and the plan developed
12.29under subdivision 3, paragraph (b). If the licensee is not in compliance, the county
12.30social services agency shall notify the commissioners commissioner of the Departments
12.31 Department of of Health and the commissioner of the Department of Human Services.
12.32(g) Except as requested by the resident, family member, or designated representative
12.33 or responsible party and within the parameters of the Vulnerable Adults Act, the
12.34county social services agency, in coordination with the commissioner of health and the
12.35commissioner of human services, may halt a relocation that it deems inappropriate or
12.36dangerous to the health or safety of a resident. In situations where a resident relocation
13.1is halted, the county social services agency must notify the resident, family, responsible
13.2parties, Office of the Ombudsman for Long-Term Care and Office of the Ombudsman for
13.3Mental Health and Developmental Disabilities, and resident's managed care organization,
13.4of this action. The county social services agency shall pursue remedies to protect the
13.5resident during the relocation process, including, but not limited to, assisting the resident
13.6with filing an appeal of transfer or discharge, notification of all appropriate licensing
13.7boards and agencies, and other remedies available to the county under section 626.557,
13.8subdivision 10.
13.9(h) A member of the county social services agency staff shall visit follow up
13.10with relocated residents relocated within 100 miles of the county within 30 days after
13.11the relocation. This requirement does not apply to changes in operation where the
13.12facility moved to a new location and residents chose to move to that new location.
13.13The requirement also does not apply to residents admitted after the notice of closure
13.14 in subdivision 5a is given and discharged prior to the actual closure change in facility
13.15operations or reduction. County social services agency staff shall interview the resident
13.16and family or designated representative, observe the resident on site, responsible party and
13.17review and discuss pertinent medical or social records with appropriate facility staff to:
13.18(1) assess the adjustment of the resident to the new placement;
13.19(2) recommend services or methods to meet any special needs of the resident; and
13.20(3) identify residents at risk.
13.21(i) The county social services agency may shall conduct subsequent follow-up visits
13.22 on-site in cases where the adjustment of the resident to the new placement is in question.
13.23(j) Within 60 days of the completion of the follow-up visits under paragraphs (h) and
13.24(i), the county social services agency shall submit a written summary of the follow-up
13.25work to the Departments Department of Health and the Department of Human Services in
13.26a manner approved by the commissioners.
13.27(k) The county social services agency shall submit to the Departments Department
13.28 of Health and the Department of Human Services a report of any issues that may require
13.29further review or monitoring.
13.30(l) The county social services agency shall be responsible for the safe and orderly
13.31relocation of residents in cases where an emergent need arises or when the licensee has
13.32abrogated its responsibilities under the plan.
13.33    Subd. 9. Penalties. Upon the recommendation of the commissioner of health,
13.34the commissioner of human services may eliminate a closure rate adjustment under
13.35subdivision 10 for violations of this section.
14.1    Subd. 10. Facility closure rate adjustment. Upon the request of a closing facility,
14.2the commissioner of human services must allow the facility a closure rate adjustment equal
14.3to a 50 percent payment rate increase to reimburse relocation costs or other costs related to
14.4facility closure. This rate increase is effective on the date the facility's occupancy decreases
14.5to 90 percent of capacity days after the written notice of closure is distributed under
14.6subdivision 5 and shall remain in effect for a period of up to 60 days. The commissioner
14.7shall delay the implementation of rate adjustments under section 256B.437, subdivisions
14.83, paragraph (b) , and 6, paragraph (a), to offset the cost of this rate adjustment.
14.9    Subd. 11. County costs. The commissioner of human services shall allocate up
14.10to $450 in total state and federal funds per nursing facility bed that is closing, within
14.11the limits of the appropriation specified for this purpose, to be used for relocation costs
14.12incurred by counties for resident relocation under this section or planned closures under
14.13section 256B.437. To be eligible for this allocation, a county in which a nursing facility
14.14closes must provide to the commissioner a detailed statement in a form provided by the
14.15commissioner of additional costs, not to exceed $450 in total state and federal funds per
14.16bed closed, that are directly incurred related to the county's role in the relocation process.

14.17    Sec. 5. Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:
14.18    Subd. 3. Asset limitations for individuals and families. (a) To be eligible for
14.19medical assistance, a person must not individually own more than $3,000 in assets, or if a
14.20member of a household with two family members, husband and wife, or parent and child,
14.21the household must not own more than $6,000 in assets, plus $200 for each additional
14.22legal dependent. In addition to these maximum amounts, an eligible individual or family
14.23may accrue interest on these amounts, but they must be reduced to the maximum at the
14.24time of an eligibility redetermination. The accumulation of the clothing and personal
14.25needs allowance according to section 256B.35 must also be reduced to the maximum at
14.26the time of the eligibility redetermination. The value of assets that are not considered in
14.27determining eligibility for medical assistance is the value of those assets excluded under
14.28the supplemental security income program for aged, blind, and disabled persons, with
14.29the following exceptions:
14.30    (1) household goods and personal effects are not considered;
14.31    (2) capital and operating assets of a trade or business that the local agency determines
14.32are necessary to the person's ability to earn an income are not considered;
14.33    (3) motor vehicles are excluded to the same extent excluded by the supplemental
14.34security income program;
15.1    (4) assets designated as burial expenses are excluded to the same extent excluded by
15.2the supplemental security income program. Burial expenses funded by annuity contracts
15.3or life insurance policies must irrevocably designate the individual's estate as contingent
15.4beneficiary to the extent proceeds are not used for payment of selected burial expenses;
15.5    (5) for a person who no longer qualifies as an employed person with a disability due
15.6to loss of earnings, assets allowed while eligible for medical assistance under section
15.7256B.057, subdivision 9 , are not considered for 12 months, beginning with the first month
15.8of ineligibility as an employed person with a disability, to the extent that the person's total
15.9assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
15.10    (6) when a person enrolled in medical assistance under section 256B.057, subdivision
15.119 , is age 65 or older and has been enrolled during each of the 24 consecutive months
15.12before the person's 65th birthday, the assets owned by the person and the person's spouse
15.13must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d),
15.14when determining eligibility for medical assistance under section 256B.055, subdivision
15.157 . The income of a spouse of a person enrolled in medical assistance under section
15.16256B.057, subdivision 9 , during each of the 24 consecutive months before the person's
15.1765th birthday must be disregarded when determining eligibility for medical assistance
15.18under section 256B.055, subdivision 7. Persons eligible under this clause are not subject to
15.19the provisions in section 256B.059. A person whose 65th birthday occurs in 2012 or 2013
15.20is required to have qualified for medical assistance under section 256B.057, subdivision 9,
15.21prior to age 65 for at least 20 months in the 24 months prior to reaching age 65; and
15.22    (7) effective July 1, 2009, certain assets owned by American Indians are excluded as
15.23required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
15.24Law 111-5. For purposes of this clause, an American Indian is any person who meets the
15.25definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
15.26    (b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.2715.
15.28EFFECTIVE DATE.This section is effective January 1, 2014.

15.29    Sec. 6. Minnesota Statutes 2012, section 256B.057, subdivision 9, is amended to read:
15.30    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid
15.31for a person who is employed and who:
15.32(1) but for excess earnings or assets, meets the definition of disabled under the
15.33Supplemental Security Income program;
15.34(2) meets the asset limits in paragraph (d); and
15.35(3) pays a premium and other obligations under paragraph (e).
16.1    (b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
16.2for medical assistance under this subdivision, a person must have more than $65 of earned
16.3income. Earned income must have Medicare, Social Security, and applicable state and
16.4federal taxes withheld. The person must document earned income tax withholding. Any
16.5spousal income or assets shall be disregarded for purposes of eligibility and premium
16.6determinations.
16.7(c) After the month of enrollment, a person enrolled in medical assistance under
16.8this subdivision who:
16.9(1) is temporarily unable to work and without receipt of earned income due to a
16.10medical condition, as verified by a physician; or
16.11(2) loses employment for reasons not attributable to the enrollee, and is without
16.12receipt of earned income may retain eligibility for up to four consecutive months after the
16.13month of job loss. To receive a four-month extension, enrollees must verify the medical
16.14condition or provide notification of job loss. All other eligibility requirements must be met
16.15and the enrollee must pay all calculated premium costs for continued eligibility.
16.16(d) For purposes of determining eligibility under this subdivision, a person's assets
16.17must not exceed $20,000, excluding:
16.18(1) all assets excluded under section 256B.056;
16.19(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
16.20Keogh plans, and pension plans;
16.21(3) medical expense accounts set up through the person's employer; and
16.22(4) spousal assets, including spouse's share of jointly held assets.
16.23(e) All enrollees must pay a premium to be eligible for medical assistance under this
16.24subdivision, except as provided under clause (5).
16.25(1) An enrollee must pay the greater of a $65 premium or the premium calculated
16.26based on the person's gross earned and unearned income and the applicable family size
16.27using a sliding fee scale established by the commissioner, which begins at one percent of
16.28income at 100 percent of the federal poverty guidelines and increases to 7.5 percent of
16.29income for those with incomes at or above 300 percent of the federal poverty guidelines.
16.30(2) Annual adjustments in the premium schedule based upon changes in the federal
16.31poverty guidelines shall be effective for premiums due in July of each year.
16.32(3) All enrollees who receive unearned income must pay five percent of unearned
16.33income in addition to the premium amount, except as provided under clause (5).
16.34(4) Increases in benefits under title II of the Social Security Act shall not be counted
16.35as income for purposes of this subdivision until July 1 of each year.
17.1(5) Effective July 1, 2009, American Indians are exempt from paying premiums as
17.2required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
17.3Law 111-5. For purposes of this clause, an American Indian is any person who meets the
17.4definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
17.5(f) A person's eligibility and premium shall be determined by the local county
17.6agency. Premiums must be paid to the commissioner. All premiums are dedicated to
17.7the commissioner.
17.8(g) Any required premium shall be determined at application and redetermined at
17.9the enrollee's six-month income review or when a change in income or household size is
17.10reported. Enrollees must report any change in income or household size within ten days
17.11of when the change occurs. A decreased premium resulting from a reported change in
17.12income or household size shall be effective the first day of the next available billing month
17.13after the change is reported. Except for changes occurring from annual cost-of-living
17.14increases, a change resulting in an increased premium shall not affect the premium amount
17.15until the next six-month review.
17.16(h) Premium payment is due upon notification from the commissioner of the
17.17premium amount required. Premiums may be paid in installments at the discretion of
17.18the commissioner.
17.19(i) Nonpayment of the premium shall result in denial or termination of medical
17.20assistance unless the person demonstrates good cause for nonpayment. Good cause exists
17.21if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
17.22D, are met. Except when an installment agreement is accepted by the commissioner, all
17.23persons disenrolled for nonpayment of a premium must pay any past due premiums as well
17.24as current premiums due prior to being reenrolled. Nonpayment shall include payment with
17.25a returned, refused, or dishonored instrument. The commissioner may require a guaranteed
17.26form of payment as the only means to replace a returned, refused, or dishonored instrument.
17.27(j) The commissioner shall notify enrollees annually beginning at least 24 months
17.28before the person's 65th birthday of the medical assistance eligibility rules affecting
17.29income, assets, and treatment of a spouse's income and assets that will be applied upon
17.30reaching age 65.
17.31(k) (j) For enrollees whose income does not exceed 200 percent of the federal
17.32poverty guidelines and who are also enrolled in Medicare, the commissioner shall
17.33reimburse the enrollee for Medicare part B premiums under section 256B.0625,
17.34subdivision 15 , paragraph (a).

17.35    Sec. 7. Minnesota Statutes 2012, section 256B.0652, subdivision 5, is amended to read:
18.1    Subd. 5. Authorization; private duty nursing services. (a) All private duty
18.2nursing services shall be authorized by the commissioner or the commissioner's designee.
18.3Authorization for private duty nursing services shall be based on medical necessity and
18.4cost-effectiveness when compared with alternative care options. The commissioner may
18.5authorize medically necessary private duty nursing services in quarter-hour units when:
18.6(1) the recipient requires more individual and continuous care than can be provided
18.7during a skilled nurse visit; or
18.8(2) the cares are outside of the scope of services that can be provided by a home
18.9health aide or personal care assistant.
18.10(b) The commissioner may authorize:
18.11(1) up to two times the average amount of direct care hours provided in nursing
18.12facilities statewide for case mix classification "K" as established by the annual cost report
18.13submitted to the department by nursing facilities in May 1992;
18.14(2) private duty nursing in combination with other home care services up to the total
18.15cost allowed under this subdivision and section 256B.0652, subdivision 6 subdivision 7;
18.16(3) up to 16 hours per day if the recipient requires more nursing than the maximum
18.17number of direct care hours as established in clause (1) and the recipient meets the hospital
18.18admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540, but
18.19for the provision of the nursing services, the recipient would require a hospital level of
18.20care as defined in Code of Federal Regulations, title 42, section 440.10.
18.21(c) The commissioner may authorize up to 16 hours per day of medically necessary
18.22private duty nursing services or up to 24 hours per day of medically necessary private duty
18.23nursing services until such time as the commissioner is able to make a determination of
18.24eligibility for recipients who are cooperatively applying for home care services under
18.25the community alternative care program developed under section 256B.49, or until it is
18.26determined by the appropriate regulatory agency that a health benefit plan is or is not
18.27required to pay for appropriate medically necessary health care services. Recipients or their
18.28representatives must cooperatively assist the commissioner in obtaining this determination.
18.29Recipients who are eligible for the community alternative care program may not receive
18.30more hours of nursing under this section and sections 256B.0651, 256B.0653, 256B.0656,
18.31and 256B.0659 than would otherwise be authorized under section 256B.49.

18.32    Sec. 8. Minnesota Statutes 2012, section 256B.0659, subdivision 7, is amended to read:
18.33    Subd. 7. Personal care assistance care plan. (a) Each recipient must have a
18.34current personal care assistance care plan based on the service plan in subdivision 6 that is
18.35developed by the qualified professional with the recipient and responsible party. A copy of
19.1the most current personal care assistance care plan is required to be in the recipient's home
19.2and in the recipient's file at the provider agency.
19.3    (b) The personal care assistance care plan must have the following components:
19.4    (1) start and end date of the care plan;
19.5    (2) recipient demographic information, including name and telephone number;
19.6    (3) emergency numbers, procedures, and a description of measures to address
19.7identified safety and vulnerability issues, including a backup staffing plan;
19.8    (4) name of responsible party and instructions for contact;
19.9    (5) description of the recipient's individualized needs for assistance with activities of
19.10daily living, instrumental activities of daily living, health-related tasks, and behaviors; and
19.11    (6) dated signatures of recipient or responsible party and qualified professional.
19.12    (c) The personal care assistance care plan must have instructions and comments
19.13about the recipient's needs for assistance and any special instructions or procedures
19.14required, including whether or not the recipient has requested a personal care assistant
19.15of the same gender. The month-to-month plan for the use of personal care assistance
19.16services is part of the personal care assistance care plan. The personal care assistance
19.17care plan must be completed within the first week after start of services with a personal
19.18care provider agency and must be updated as needed when there is a change in need for
19.19personal care assistance services. A new personal care assistance care plan is required
19.20annually at the time of the reassessment.

19.21    Sec. 9. Minnesota Statutes 2012, section 256B.0659, is amended by adding a
19.22subdivision to read:
19.23    Subd. 7a. Special instructions; gender. If a recipient requests a personal care
19.24assistant of the same gender as the recipient, the personal care assistance agency must
19.25make a reasonable effort to fulfill the request.

19.26    Sec. 10. Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to
19.27read:
19.28    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
19.29services planning, or other assistance intended to support community-based living,
19.30including persons who need assessment in order to determine waiver or alternative care
19.31program eligibility, must be visited by a long-term care consultation team within 20
19.32calendar days after the date on which an assessment was requested or recommended.
19.33Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
19.34applies to an assessment of a person requesting personal care assistance services and
20.1private duty nursing. The commissioner shall provide at least a 90-day notice to lead
20.2agencies prior to the effective date of this requirement. Face-to-face assessments must be
20.3conducted according to paragraphs (b) to (i).
20.4    (b) The lead agency may utilize a team of either the social worker or public health
20.5nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
20.6use certified assessors to conduct the assessment. The consultation team members must
20.7confer regarding the most appropriate care for each individual screened or assessed. For
20.8a person with complex health care needs, a public health or registered nurse from the
20.9team must be consulted.
20.10    (c) The assessment must be comprehensive and include a person-centered assessment
20.11of the health, psychological, functional, environmental, and social needs of referred
20.12individuals and provide information necessary to develop a community support plan that
20.13meets the consumers needs, using an assessment form provided by the commissioner.
20.14    (d) The assessment must be conducted in a face-to-face interview with the person
20.15being assessed and the person's legal representative, and other individuals as requested by
20.16the person, who can provide information on the needs, strengths, and preferences of the
20.17person necessary to develop a community support plan that ensures the person's health and
20.18safety, but who is not a provider of service or has any financial interest in the provision
20.19of services. For persons who are to be assessed for elderly waiver customized living
20.20services under section 256B.0915, with the permission of the person being assessed or
20.21the person's designated or legal representative, the client's current or proposed provider
20.22of services may submit a copy of the provider's nursing assessment or written report
20.23outlining its recommendations regarding the client's care needs. The person conducting
20.24the assessment will notify the provider of the date by which this information is to be
20.25submitted. This information shall be provided to the person conducting the assessment
20.26prior to the assessment. For a person who is to be assessed for waiver services under
20.27section 256B.092 or 256B.49, with the permission of the person being assessed or the
20.28person's designated legal representative, the person's current provider of services may
20.29submit a written report outlining recommendations regarding the person's care needs
20.30prepared by a direct service employee with a least 20 hours of service to that client. The
20.31person conducting the assessment or reassessment must notify the provider of the date
20.32by which this information is to be submitted. This information shall be provided to the
20.33person conducting the assessment and the person or the person's legal representative, and
20.34must be considered prior to the finalization of the assessment or reassessment.
20.35    (e) If the person chooses to use community-based services, the person or the person's
20.36legal representative must be provided with a written community support plan within 40
21.1calendar days of the assessment visit, regardless of whether the individual is eligible for
21.2Minnesota health care programs. The written community support plan must include:
21.3(1) a summary of assessed needs as defined in paragraphs (c) and (d);
21.4(2) the individual's options and choices to meet identified needs, including all
21.5available options for case management services and providers;
21.6(3) identification of health and safety risks and how those risks will be addressed,
21.7including personal risk management strategies;
21.8(4) referral information; and
21.9(5) informal caregiver supports, if applicable.
21.10For a person determined eligible for state plan home care under subdivision 1a,
21.11paragraph (b), clause (1), the person or person's representative must also receive a copy of
21.12the home care service plan developed by the certified assessor.
21.13(f) A person may request assistance in identifying community supports without
21.14participating in a complete assessment. Upon a request for assistance identifying
21.15community support, the person must be transferred or referred to long-term care options
21.16counseling services available under sections 256.975, subdivision 7, and 256.01,
21.17subdivision 24, for telephone assistance and follow up.
21.18    (g) The person has the right to make the final decision between institutional
21.19placement and community placement after the recommendations have been provided,
21.20except as provided in subdivision 4a, paragraph (c).
21.21    (h) The lead agency must give the person receiving assessment or support planning,
21.22or the person's legal representative, materials, and forms supplied by the commissioner
21.23containing the following information:
21.24    (1) written recommendations for community-based services and consumer-directed
21.25options;
21.26(2) documentation that the most cost-effective alternatives available were offered to
21.27the individual. For purposes of this clause, "cost-effective" means community services and
21.28living arrangements that cost the same as or less than institutional care. For an individual
21.29found to meet eligibility criteria for home and community-based service programs under
21.30section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
21.31approved waiver plan for each program;
21.32(3) the need for and purpose of preadmission screening if the person selects nursing
21.33facility placement;
21.34    (4) the role of long-term care consultation assessment and support planning in
21.35eligibility determination for waiver and alternative care programs, and state plan home
22.1care, case management, and other services as defined in subdivision 1a, paragraphs (a),
22.2clause (7), and (b);
22.3    (5) information about Minnesota health care programs;
22.4    (6) the person's freedom to accept or reject the recommendations of the team;
22.5    (7) the person's right to confidentiality under the Minnesota Government Data
22.6Practices Act, chapter 13;
22.7    (8) the certified assessor's decision regarding the person's need for institutional level
22.8of care as determined under criteria established in section 256B.0911, subdivision 4a,
22.9paragraph (d), and the certified assessor's decision regarding eligibility for all services and
22.10programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
22.11    (9) the person's right to appeal the certified assessor's decision regarding eligibility
22.12for all services and programs as defined in subdivision 1a, paragraphs (a), clause clauses
22.13 (7), (8), and (9), and (b), and incorporating the decision regarding the need for institutional
22.14level of care or the lead agency's final decisions regarding public programs eligibility
22.15according to section 256.045, subdivision 3.
22.16    (i) Face-to-face assessment completed as part of eligibility determination for
22.17the alternative care, elderly waiver, community alternatives for disabled individuals,
22.18community alternative care, and brain injury waiver programs under sections 256B.0913,
22.19256B.0915 , and 256B.49 is valid to establish service eligibility for no more than 60
22.20calendar days after the date of assessment.
22.21(j) The effective eligibility start date for programs in paragraph (i) can never be
22.22prior to the date of assessment. If an assessment was completed more than 60 days
22.23before the effective waiver or alternative care program eligibility start date, assessment
22.24and support plan information must be updated in a face-to-face visit and documented in
22.25the department's Medicaid Management Information System (MMIS). Notwithstanding
22.26retroactive medical assistance coverage of state plan services, the effective date of
22.27eligibility for programs included in paragraph (i) cannot be prior to the date the most
22.28recent updated assessment is completed.

22.29    Sec. 11. Minnesota Statutes 2012, section 256B.092, subdivision 7, is amended to read:
22.30    Subd. 7. Screening teams Assessments. (a) Assessments and reassessments shall
22.31be conducted by certified assessors according to section 256B.0911, and must incorporate
22.32appropriate referrals to determine eligibility for case management under subdivision 1a.
22.33(b) For persons with developmental disabilities, screening teams a certified assessor
22.34 shall be established which shall evaluate the need for the an institutional level of care
22.35provided by residential-based habilitation services, residential services, training and
23.1habilitation services, and nursing facility services. The evaluation assessment shall
23.2address whether home and community-based services are appropriate for persons who
23.3are at risk of placement in an intermediate care facility for persons with developmental
23.4disabilities, or for whom there is reasonable indication that they might require this level of
23.5care. The screening team certified assessor shall make an evaluation of need within 60
23.6 five working days of a request for service by a person with a developmental disability,
23.7and within five working days of an emergency admission of a person to an intermediate
23.8care facility for persons with developmental disabilities.
23.9(b) The screening team shall consist of the case manager for persons with
23.10developmental disabilities, the person, the person's legal guardian or conservator, or the
23.11parent if the person is a minor, and a qualified developmental disability professional, as
23.12defined in Code of Federal Regulations, title 42, section 483.430, as amended through
23.13June 3, 1988. The case manager may also act as the qualified developmental disability
23.14professional if the case manager meets the federal definition.
23.15(c) County social service agencies may contract with a public or private agency
23.16or individual who is not a service provider for the person for the public guardianship
23.17representation required by the screening or individual service planning process. The
23.18contract shall be limited to public guardianship representation for the screening and
23.19individual service planning activities. The contract shall require compliance with the
23.20commissioner's instructions and may be for paid or voluntary services.
23.21(d) For persons determined to have overriding health care needs and are
23.22seeking admission to a nursing facility or an ICF/MR, or seeking access to home and
23.23community-based waivered services, a registered nurse must be designated as either the
23.24case manager or the qualified developmental disability professional.
23.25(e) For persons under the jurisdiction of a correctional agency, the case manager
23.26must consult with the corrections administrator regarding additional health, safety, and
23.27supervision needs.
23.28(f) (c) The case manager certified assessor, with the concurrence of the person, the
23.29person's legal guardian or conservator, or the parent if the person is a minor, may invite other
23.30individuals to attend meetings of the screening team the assessment. With the permission
23.31of the person being screened assessed or the person's designated legal representative,
23.32the person's current provider of services may submit a written report outlining their
23.33recommendations regarding the person's care needs prepared by a direct service employee
23.34with at least 20 hours of service to that client. The screening team assessor must notify
23.35the provider of the date by which this information is to be submitted. This information
24.1must be provided to the screening team assessor and the person or the person's legal
24.2representative and must be considered prior to the finalization of the screening assessment.
24.3(g) No member of the screening team shall have any direct or indirect service
24.4provider interest in the case.
24.5(h) Nothing in this section shall be construed as requiring the screening team
24.6meeting to be separate from the service planning meeting.

24.7    Sec. 12. Minnesota Statutes 2012, section 256B.441, subdivision 1, is amended to read:
24.8    Subdivision 1. Rebasing of nursing facility operating payment rates. (a) The
24.9commissioner shall rebase nursing facility operating payment rates to align payments to
24.10facilities with the cost of providing care. The rebased operating payment rates shall be
24.11calculated using the statistical and cost report filed by each nursing facility for the report
24.12period ending one year prior to the rate year.
24.13    (b) The new operating payment rates based on this section shall take effect beginning
24.14with the rate year beginning October 1, 2008, and shall be phased in over eight rate years
24.15through October 1, 2015. For each year of the phase-in, the operating payment rates shall
24.16be calculated using the statistical and cost report filed by each nursing facility for the
24.17report period ending one year prior to the rate year.
24.18    (c) Operating payment rates shall be rebased on October 1, 2016, and every two
24.19years after that date.
24.20    (d) Each cost reporting year shall begin on October 1 and end on the following
24.21September 30. Beginning in 2006 2014, a statistical and cost report shall be filed by each
24.22nursing facility by January 15 February 1. Notice of rates shall be distributed by August
24.2315 and the rates shall go into effect on October 1 for one year.
24.24    (e) Effective October 1, 2014, property rates shall be rebased in accordance with
24.25section 256B.431 and Minnesota Rules, chapter 9549. The commissioner shall determine
24.26what the property payment rate for a nursing facility would be had the facility not had its
24.27property rate determined under section 256B.434. The commissioner shall allow nursing
24.28facilities to provide information affecting this rate determination that would have been
24.29filed annually under Minnesota Rules, chapter 9549, and nursing facilities shall report
24.30information necessary to determine allowable debt. The commissioner shall use this
24.31information to determine the property payment rate.

24.32    Sec. 13. Minnesota Statutes 2012, section 256B.441, subdivision 43, is amended to read:
24.33    Subd. 43. Reporting of statistical and cost information. (a) Beginning in 2006,
24.34all nursing facilities shall provide information annually to the commissioner on a form
25.1and in a manner determined by the commissioner. The commissioner may also require
25.2nursing facilities to provide statistical and cost information for a subset of the items in
25.3the annual report on a semiannual basis. Nursing facilities shall report only costs directly
25.4related to the operation of the nursing facility. The facility shall not include costs which
25.5are separately reimbursed by residents, medical assistance, or other payors. Allocations
25.6of costs from central, affiliated, or corporate office and related organization transactions
25.7shall be reported according to section 256B.432. Beginning with the September 30, 2013,
25.8reporting year, the commissioner may shall no longer grant to facilities one extension of
25.9up to 15 days for the filing of this report if the extension is requested by December 15 and
25.10the commissioner determines that the extension will not prevent the commissioner from
25.11establishing rates in a timely manner required by law extensions to the filing deadline.
25.12The commissioner may separately require facilities to submit in a manner specified by
25.13the commissioner documentation of statistical and cost information included in the report
25.14to ensure accuracy in establishing payment rates and to perform audit and appeal review
25.15functions under this section. Facilities shall retain all records necessary to document
25.16statistical and cost information on the report for a period of no less than seven years.
25.17The commissioner may amend information in the report according to subdivision 47.
25.18The commissioner may reject a report filed by a nursing facility under this section if the
25.19commissioner determines that the report has been filed in a form that is incomplete or
25.20inaccurate and the information is insufficient to establish accurate payment rates. In the
25.21event that a complete report is not submitted in a timely manner, the commissioner shall
25.22reduce the reimbursement payments to a nursing facility to 85 percent of amounts due
25.23until the information is filed. The release of withheld payments shall be retroactive for
25.24no more than 90 days. A nursing facility that does not submit a report or whose report is
25.25filed in a timely manner but determined to be incomplete shall be given written notice that
25.26a payment reduction is to be implemented and allowed ten days to complete the report
25.27prior to any payment reduction. The commissioner may delay the payment withhold under
25.28exceptional circumstances to be determined at the sole discretion of the commissioner.
25.29(b) Nursing facilities may, within 12 months of the due date of a statistical and
25.30cost report, file an amendment when errors or omissions in the annual statistical and
25.31cost report are discovered and an amendment would result in a rate increase of at least
25.320.15 percent of the statewide weighted average operating payment rate and shall, at any
25.33time, file an amendment which would result in a rate reduction of at least 0.15 percent of
25.34the statewide weighted average operating payment rate. The commissioner shall make
25.35retroactive adjustments to the total payment rate of a nursing facility if an amendment is
25.36accepted. Where a retroactive adjustment is to be made as a result of an amended report,
26.1audit findings, or other determination of an incorrect payment rate, the commissioner may
26.2settle the payment error through a negotiated agreement with the facility and a gross
26.3adjustment of the payments to the facility. Retroactive adjustments shall not be applied
26.4to private pay residents. An error or omission for purposes of this item does not include
26.5a nursing facility's determination that an election between permissible alternatives was
26.6not advantageous and should be changed.
26.7(c) If the commissioner determines that a nursing facility knowingly supplied
26.8inaccurate or false information or failed to file an amendment to a statistical and cost report
26.9that resulted in or would result in an overpayment, the commissioner shall immediately
26.10adjust the nursing facility's payment rate and recover the entire overpayment. The
26.11commissioner may also terminate the commissioner's agreement with the nursing facility
26.12and prosecute under applicable state or federal law.

26.13    Sec. 14. Minnesota Statutes 2012, section 256B.441, subdivision 63, is amended to read:
26.14    Subd. 63. Critical access nursing facilities. (a) The commissioner, in consultation
26.15with the commissioner of health, may designate certain nursing facilities as critical access
26.16nursing facilities. The designation shall be granted on a competitive basis, within the
26.17limits of funds appropriated for this purpose.
26.18(b) The commissioner shall request proposals from nursing facilities every two years.
26.19Proposals must be submitted in the form and according to the timelines established by
26.20the commissioner. In selecting applicants to designate, the commissioner, in consultation
26.21with the commissioner of health, and with input from stakeholders, shall develop criteria
26.22designed to preserve access to nursing facility services in isolated areas, rebalance
26.23long-term care, and improve quality.
26.24(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing
26.25facilities designated as critical access nursing facilities:
26.26(1) partial rebasing, with operating payment rates being the sum of 60 percent of the
26.27operating payment rate determined in accordance with subdivision 54 and 40 percent of the
26.28operating payment rate that would have been allowed had the facility not been designated;
26.29(2) enhanced payments for leave days. Notwithstanding section 256B.431,
26.30subdivision 2r, upon designation as a critical access nursing facility, the commissioner
26.31shall limit payment for leave days to 60 percent of that nursing facility's total payment rate
26.32for the involved resident, and shall allow this payment only when the occupancy of the
26.33nursing facility, inclusive of bed hold days, is equal to or greater than 90 percent;
26.34(3) two designated critical access nursing facilities, with up to 100 beds in active
26.35service, may jointly apply to the commissioner of health for a waiver of Minnesota
27.1Rules, part 4658.0500, subpart 2, in order to jointly employ a director of nursing. The
27.2commissioner of health will consider each waiver request independently based on the
27.3criteria under Minnesota Rules, part 4658.0040;
27.4(4) the minimum threshold under section 256B.431, subdivisions 3f, paragraph (a),
27.5and 17e subdivision 15, paragraph (e), shall be 40 percent of the amount that would
27.6otherwise apply; and
27.7(5) notwithstanding subdivision 58, beginning October 1, 2014, the quality-based
27.8rate limits under subdivision 50 shall apply to designated critical access nursing facilities.
27.9(d) Designation of a critical access nursing facility shall be for a period of two
27.10years, after which the benefits allowed under paragraph (c) shall be removed. Designated
27.11facilities may apply for continued designation.
27.12EFFECTIVE DATE.This section is effective the day following final enactment.

27.13    Sec. 15. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
27.14    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
27.15shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
27.16The certified assessor, with the permission of the recipient or the recipient's designated
27.17legal representative, may invite other individuals to attend the assessment. With the
27.18permission of the recipient or the recipient's designated legal representative, the recipient's
27.19current provider of services may submit a written report outlining their recommendations
27.20regarding the recipient's care needs prepared by a direct service employee with at least
27.2120 hours of service to that client. The person conducting the assessment or reassessment
27.22 certified assessor must notify the provider of the date by which this information is to be
27.23submitted. This information shall be provided to the person conducting the assessment
27.24 certified assessor and the person or the person's legal representative and must be
27.25considered prior to the finalization of the assessment or reassessment.
27.26(b) There must be a determination that the client requires a hospital level of care or a
27.27nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
27.28(d), at initial and subsequent assessments to initiate and maintain participation in the
27.29waiver program.
27.30(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
27.31appropriate to determine nursing facility level of care for purposes of medical assistance
27.32payment for nursing facility services, only face-to-face assessments conducted according
27.33to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
27.34determination or a nursing facility level of care determination must be accepted for
27.35purposes of initial and ongoing access to waiver services payment.
28.1(d) Recipients who are found eligible for home and community-based services under
28.2this section before their 65th birthday may remain eligible for these services after their
28.365th birthday if they continue to meet all other eligibility factors.
28.4(e) The commissioner shall develop criteria to identify recipients whose level of
28.5functioning is reasonably expected to improve and reassess these recipients to establish
28.6a baseline assessment. Recipients who meet these criteria must have a comprehensive
28.7transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
28.8reassessed every six months until there has been no significant change in the recipient's
28.9functioning for at least 12 months. After there has been no significant change in the
28.10recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
28.11informal support systems, and need for services shall be conducted at least every 12
28.12months and at other times when there has been a significant change in the recipient's
28.13functioning. Counties, case managers, and service providers are responsible for
28.14conducting these reassessments and shall complete the reassessments out of existing funds.

28.15    Sec. 16. Minnesota Statutes 2012, section 256B.492, is amended to read:
28.16256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
28.17WITH DISABILITIES.
28.18(a) Individuals receiving services under a home and community-based waiver under
28.19section 256B.092 or 256B.49 may receive services in the following settings:
28.20(1) an individual's own home or family home;
28.21(2) a licensed adult foster care or child foster care setting of up to five people; and
28.22(3) community living settings as defined in section 256B.49, subdivision 23, where
28.23individuals with disabilities may reside in all of the units in a building of four or fewer
28.24units, and no more than the greater of four or 25 percent of the units in a multifamily
28.25building of more than four units.
28.26(b) The settings in paragraph (a) must not:
28.27(1) be located in a building that is a publicly or privately operated facility that
28.28provides institutional treatment or custodial care;
28.29(2) be located in a building on the grounds of or adjacent to a public or private
28.30institution;
28.31(3) be a housing complex designed expressly around an individual's diagnosis or
28.32disability;
28.33(4) be segregated based on a disability, either physically or because of setting
28.34characteristics, from the larger community; and
29.1(5) have the qualities of an institution which include, but are not limited to:
29.2regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
29.3agreed to and documented in the person's individual service plan shall not result in a
29.4residence having the qualities of an institution as long as the restrictions for the person are
29.5not imposed upon others in the same residence and are the least restrictive alternative,
29.6imposed for the shortest possible time to meet the person's needs.
29.7(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
29.8individuals receive services under a home and community-based waiver as of July 1,
29.92012, and the setting does not meet the criteria of this section.
29.10(d) Notwithstanding paragraph (c), a program in Hennepin County established as
29.11part of a Hennepin County demonstration project is qualified for the exception allowed
29.12under paragraph (c).
29.13(e) The commissioner shall submit an amendment to the waiver plan no later than
29.14December 31, 2012.

29.15    Sec. 17. Minnesota Statutes 2012, section 626.557, subdivision 10, is amended to read:
29.16    Subd. 10. Duties of county social service agency. (a) Upon receipt of a report from
29.17the common entry point staff, the county social service agency shall immediately assess
29.18and offer emergency and continuing protective social services for purposes of preventing
29.19further maltreatment and for safeguarding the welfare of the maltreated vulnerable adult.
29.20The county shall use a standardized tool made available by the commissioner. The
29.21information entered by the county into the standardized tool must be accessible to the
29.22Department of Human Services. In cases of suspected sexual abuse, the county social
29.23service agency shall immediately arrange for and make available to the vulnerable adult
29.24appropriate medical examination and treatment. When necessary in order to protect the
29.25vulnerable adult from further harm, the county social service agency shall seek authority
29.26to remove the vulnerable adult from the situation in which the maltreatment occurred. The
29.27county social service agency may also investigate to determine whether the conditions
29.28which resulted in the reported maltreatment place other vulnerable adults in jeopardy of
29.29being maltreated and offer protective social services that are called for by its determination.
29.30(b) County social service agencies may enter facilities and inspect and copy records
29.31as part of an investigation. The county social service agency has access to not public
29.32data, as defined in section 13.02, and medical records under sections 144.291 to 144.298,
29.33that are maintained by facilities to the extent necessary to conduct its investigation. The
29.34inquiry is not limited to the written records of the facility, but may include every other
29.35available source of information.
30.1(c) When necessary in order to protect a vulnerable adult from serious harm, the
30.2county social service agency shall immediately intervene on behalf of that adult to help
30.3the family, vulnerable adult, or other interested person by seeking any of the following:
30.4(1) a restraining order or a court order for removal of the perpetrator from the
30.5residence of the vulnerable adult pursuant to section 518B.01;
30.6(2) the appointment of a guardian or conservator pursuant to sections 524.5-101 to
30.7524.5-502 , or guardianship or conservatorship pursuant to chapter 252A;
30.8(3) replacement of a guardian or conservator suspected of maltreatment and
30.9appointment of a suitable person as guardian or conservator, pursuant to sections
30.10524.5-101 to 524.5-502; or
30.11(4) a referral to the prosecuting attorney for possible criminal prosecution of the
30.12perpetrator under chapter 609.
30.13The expenses of legal intervention must be paid by the county in the case of indigent
30.14persons, under section 524.5-502 and chapter 563.
30.15In proceedings under sections 524.5-101 to 524.5-502, if a suitable relative or
30.16other person is not available to petition for guardianship or conservatorship, a county
30.17employee shall present the petition with representation by the county attorney. The county
30.18shall contract with or arrange for a suitable person or organization to provide ongoing
30.19guardianship services. If the county presents evidence to the court exercising probate
30.20jurisdiction that it has made a diligent effort and no other suitable person can be found,
30.21a county employee may serve as guardian or conservator. The county shall not retaliate
30.22against the employee for any action taken on behalf of the ward or protected person even
30.23if the action is adverse to the county's interest. Any person retaliated against in violation
30.24of this subdivision shall have a cause of action against the county and shall be entitled to
30.25reasonable attorney fees and costs of the action if the action is upheld by the court.

30.26    Sec. 18. THIRD-PARTY REIMBURSEMENT FOR LONG-TERM CARE
30.27CONSULTATION SERVICES.
30.28    The commissioner of human services shall submit a request within 60 days of
30.29final enactment to the federal government to amend the Medicaid cost allocation plan
30.30to allow county or tribal agencies to contract with nongovernmental organizations to
30.31conduct assessments under Minnesota Statutes, section 256B.0911, and be reimbursed for
30.32assessments conducted under contract. Upon federal approval, this shall be incorporated
30.33into the alternative payment methodology under Minnesota Statutes, section 256B.0911,
30.34subdivision 6, paragraph (h).

31.1    Sec. 19. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT
31.2REDESIGN.
31.3    (a) By February 1, 2014, the commissioner of human services shall develop a
31.4legislative report with specific recommendations and language for proposed legislation to:
31.5    (1) increase opportunities for choice of case management service provider;
31.6    (2) define the service of case management to include the identification of roles and
31.7activities of a case manager to avoid duplication of services;
31.8    (3) provide guidance on caseload size to reduce variation across the state;
31.9    (4) develop a statewide system to standardize case management provider standards,
31.10which may include establishing a licensure or certification process;
31.11    (5) develop reporting measures to determine outcomes for case management services
31.12to increase continuous quality improvement;
31.13    (6) establish rates for the service of case management that are transparent and
31.14consistent for all medical assistance-paid case management;
31.15    (7) develop information for case management recipients to make an informed choice
31.16of case management service provider; and
31.17    (8) provide waiver case management recipients with an itemized list of case
31.18management services provided on a monthly basis.
31.19    (b) The commissioner shall consult with existing stakeholder groups which include
31.20representatives of counties, tribes, disability and senior advocacy groups including mental
31.21health stakeholders, managed care organizations, and service providers in preparing the
31.22recommendations and language for proposed legislation. The commissioner shall present
31.23findings, recommendations, and proposed legislation to the chairs and ranking minority
31.24members of the legislative committees with jurisdiction over health and human services
31.25policy and finance by February 1, 2014.

31.26    Sec. 20. REPEALER.
31.27(a) Minnesota Statutes 2012, section 256B.437, subdivision 8, is repealed.
31.28(b) Laws 2012, chapter 216, article 11, section 31, is repealed.