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HF 1021

as introduced - 87th Legislature (2011 - 2012) Posted on 03/10/2011 09:43am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to human services; modifying long-term care consultation; modifying
elderly waiver; amending Minnesota Statutes 2010, sections 256B.0911,
subdivision 3a; 256B.0915, subdivisions 3e, 3h, 5, 6, 10.

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

Section 1.

Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to
read:


Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 15
calendar days after the date on which an assessment was requested or recommended. After
January 1, 2011, these requirements also apply to personal care assistance services, private
duty nursing, and home health agency services, on timelines established in subdivision 5.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).

(b) The county may utilize a team of either the social worker or public health nurse,
or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
assessment in a face-to-face interview. The consultation team members must confer
regarding the most appropriate care for each individual screened or assessed.

(c) The assessment must be comprehensive and include a person-centered
assessment of the health, psychological, functional, environmental, and social needs of
referred individuals and provide information necessary to develop a support plan that
meets the consumers needs, using an assessment form provided by the commissioner.

(d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, as required by legally executed
documents, and other individuals as requested by the person, new text begin including the person's
chosen provider of customized living services under section 256B.0915, subdivision 3e,
paragraph (e),
new text end who can provide information on the needs, strengths, and preferences of the
person necessary to develop a support plan that ensures the person's health and safetydeleted text begin , but
who is not a provider of service or has any financial interest in the provision of services
deleted text end .

(e) The person, or the person's legal representative, must be provided with written
recommendations for community-based services, including consumer-directed options,
or institutional care that include documentation that the most cost-effective alternatives
available were offered to the individual. For purposes of this requirement, "cost-effective
alternatives" means community services and living arrangements that cost the same as or
less than institutional care.

(f) If the person chooses to use community-based services, the person or the person's
legal representative must be provided with a written community support plan, regardless
of whether the individual is eligible for Minnesota health care programs. A person may
request assistance in identifying community supports without participating in a complete
assessment. Upon a request for assistance identifying community support, the person must
be transferred or referred to the services available under sections 256.975, subdivision 7,
and 256.01, subdivision 24, for telephone assistance and follow up.

(g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in subdivision 4a, paragraph (c).

(h) The team must give the person receiving assessment or support planning, or
the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:

(1) the need for and purpose of preadmission screening if the person selects nursing
facility placement;

(2) the role of the long-term care consultation assessment and support planning in
waiver and alternative care program eligibility determination;

(3) information about Minnesota health care programs;

(4) the person's freedom to accept or reject the recommendations of the team;

(5) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;

(6) the long-term care consultant's decision regarding the person's need for
institutional level of care as determined under criteria established in section 144.0724,
subdivision 11
, or 256B.092; and

(7) the person's right to appeal the decision regarding the need for nursing facility
level of care or the county's final decisions regarding public programs eligibility according
to section 256.045, subdivision 3.

new text begin The person's chosen provider of customized living services under section 256B.0915,
subdivision 3e, paragraph (e), must also be provided with a copy of the long-term care
consultant's assessment as well as the decision regarding the person's need for institutional
level of care as determined under criteria established in section 144.0724, subdivision 11,
or 256B.092.
new text end

(i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and traumatic brain injury waiver programs under sections
256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more
than 60 calendar days after the date of assessment. The effective eligibility start date
for these programs can never be prior to the date of assessment. If an assessment was
completed more than 60 days before the effective waiver or alternative care program
eligibility start date, assessment and support plan information must be updated in a
face-to-face visit and documented in the department's Medicaid Management Information
System (MMIS). The effective date of program eligibility in this case cannot be prior to
the date the updated assessment is completed.

Sec. 2.

Minnesota Statutes 2010, section 256B.0915, subdivision 3e, is amended to
read:


Subd. 3e.

Customized living service rate.

(a) Payment for customized living
services shall be a monthly rate authorized by the lead agency within the parameters
established by the commissioner. The payment agreement must delineate the amount of
each component service included in the recipient's customized living service plan. The
lead agencynew text begin , in consultation with the provider of customized living services,new text end shall ensure
that there is a documented need within the parameters established by the commissioner
for all component customized living services authorized.

(b) The payment rate must be based on the amount of component services to be
provided utilizing component rates established by the commissioner. Counties and tribes
shall use tools issued by the commissioner to develop and document customized living
service plans and rates.

(c) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale. Customized
living services must not include rent or raw food costs.

(d) The individualized monthly authorized payment for the customized living
service plan shall not exceed 50 percent of the greater of either the statewide or any
of the geographic groups' weighted average monthly nursing facility rate of the case
mix resident class to which the elderly waiver eligible client would be assigned under
Minnesota Rules, parts 9549.0050 to 9549.0059, less the maintenance needs allowance
as described in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in
which the resident assessment system as described in section 256B.438 for nursing
home rate determination is implemented. Effective on July 1 of the state fiscal year in
which the resident assessment system as described in section 256B.438 for nursing
home rate determination is implemented and July 1 of each subsequent state fiscal year,
the individualized monthly authorized payment for the services described in this clause
shall not exceed the limit which was in effect on June 30 of the previous state fiscal year
updated annually based on legislatively adopted changes to all service rate maximums for
home and community-based service providers.

(e) Customized living services are delivered by a provider licensed by the
Department of Health as a class A or class F home care provider and provided in a
building that is registered as a housing with services establishment under chapter 144D.

Sec. 3.

Minnesota Statutes 2010, section 256B.0915, subdivision 3h, is amended to
read:


Subd. 3h.

Service rate limits; 24-hour customized living services.

(a) The
payment rate for 24-hour customized living services is a monthly rate authorized by the
lead agency within the parameters established by the commissioner of human services.
The payment agreement must delineate the amount of each component service included
in each recipient's customized living service plan. The lead agencynew text begin , in consultation with
the provider of customized living services,
new text end shall ensure that there is a documented need
within the parameters established by the commissioner for all component customized
living services authorized. The lead agency shall not authorize 24-hour customized living
services unless there is a documented need for 24-hour supervision.

(b) For purposes of this section, "24-hour supervision" means that the recipient
requires assistance due to needs related to one or more of the following:

(1) intermittent assistance with toileting, positioning, or transferring;

(2) cognitive or behavioral issues;

(3) a medical condition that requires clinical monitoring; or

(4) for all new participants enrolled in the program on or after January 1, 2011,
and all other participants at their first reassessment after January 1, 2011, dependency
in at least two of the following activities of daily living as determined by assessment
under section 256B.0911: bathing; dressing; grooming; walking; or eating; and needs
medication management and at least 50 hours of service per month. The lead agency shall
ensure that the frequency and mode of supervision of the recipient and the qualifications
of staff providing supervision are described and meet the needs of the recipient.

(c) The payment rate for 24-hour customized living services must be based on the
amount of component services to be provided utilizing component rates established by the
commissioner. Counties and tribes will use tools issued by the commissioner to develop
and document customized living plans and authorize rates.

(d) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale.

(e) The individually authorized 24-hour customized living payments, in combination
with the payment for other elderly waiver services, including case management, must not
exceed the recipient's community budget cap specified in subdivision 3a. Customized
living services must not include rent or raw food costs.

(f) The individually authorized 24-hour customized living payment rates shall not
exceed the 95 percentile of statewide monthly authorizations for 24-hour customized
living services in effect and in the Medicaid management information systems on March
31, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050
to 9549.0059, to which elderly waiver service clients are assigned. When there are
fewer than 50 authorizations in effect in the case mix resident class, the commissioner
shall multiply the calculated service payment rate maximum for the A classification by
the standard weight for that classification under Minnesota Rules, parts 9549.0050 to
9549.0059, to determine the applicable payment rate maximum. Service payment rate
maximums shall be updated annually based on legislatively adopted changes to all service
rates for home and community-based service providers.

(g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner
may establish alternative payment rate systems for 24-hour customized living services in
housing with services establishments which are freestanding buildings with a capacity of
16 or fewer, by applying a single hourly rate for covered component services provided
in either:

(1) licensed corporate adult foster homes; or

(2) specialized dementia care units which meet the requirements of section 144D.065
and in which:

(i) each resident is offered the option of having their own apartment; or

(ii) the units are licensed as board and lodge establishments with maximum capacity
of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
subparts 1, 2, 3, and 4, item A.

Sec. 4.

Minnesota Statutes 2010, section 256B.0915, subdivision 5, is amended to read:


Subd. 5.

Assessments and reassessments for waiver clients.

(a) Each client
shall receive an initial assessment of strengths, informal supports, and need for services
in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
client served under the elderly waiver must be conducted at least every 12 months and at
other times when the case manager determines that there has been significant change in
the client's functioning. This may include instances where the client is discharged from
the hospital. There must be a determination that the client requires nursing facility level of
care as defined in section 144.0724, subdivision 11, at initial and subsequent assessments
to initiate and maintain participation in the waiver program.

(b) Regardless of other assessments identified in section 144.0724, subdivision
4, as appropriate to determine nursing facility level of care for purposes of medical
assistance payment for nursing facility services, only face-to-face assessments conducted
according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
level of care determination will be accepted for purposes of initial and ongoing access to
waiver service payment.

new text begin (c) Notwithstanding section 256.045, subdivision 3, paragraph (a), clause (11), the
person, the person's representative, or the provider of services under this section shall
have the right to appeal determinations made under subdivisions 3e and 3h. Areas that
may be appealed include, but are not limited to: care plans, service plans, determined
rates, allocated service times, and case-mix classification assessments made under section
256B.0911, subdivision 3a. Lead agencies shall have time for corrective action before a
hearing under section 256.045, subdivision 3. Findings shall be retroactive to the date
of the appeal filing.
new text end

new text begin (d) The person, the person's representative, or the provider of services under this
section shall have the right to request a reassessment of needed services. The reassessment
shall be completed within ten working days.
new text end

Sec. 5.

Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to read:


Subd. 6.

Implementation of care plan.

Each elderly waiver clientnew text begin , and the
client's provider of services,
new text end shall be provided a copy of a written care plan that meets
the requirements outlined in section 256B.0913, subdivision 8. The care plan must be
implemented by the county of service when it is different than the county of financial
responsibility. The county of service administering waivered services must notify the
county of financial responsibility of the approved care plan.

Sec. 6.

Minnesota Statutes 2010, section 256B.0915, subdivision 10, is amended to
read:


Subd. 10.

Waiver payment rates; managed care organizations.

new text begin (a) new text end The
commissioner shall adjust the elderly waiver capitation payment rates for managed care
organizations paid under section 256B.69, subdivisions 6a and 23, to reflect the maximum
service rate limits for customized living services and 24-hour customized living services
under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical
assistance rates paid to customized living providers by managed care organizations
under this section shall not exceed the maximum service rate limits determined by the
commissioner under subdivisions 3e and 3h.

new text begin (b) Medical assistance customized living benefits under subdivision 3e, paragraph
(e), shall be effective retroactive to the date of the long-term care assessment that
establishes the needed level of services. This subdivision applies to both initial
assessments and reassessments.
new text end

new text begin (c) Managed care organizations must provide training and notification to providers
of customized living services on systems and policy changes to eligibility, billing, and
payment no less than 90 days prior to the change.
new text end

new text begin (d) The person eligible for customized living benefits under subdivision 3e,
paragraph (e), may choose to receive services from any provider that meets the standards
approved in the home and community-based services waiver for the elderly, authorized
under section 1915(c) of the Social Security Act.
new text end

new text begin (e) The person receiving services in this section with a spenddown may choose to
make their provider of services under this section a designated provider to whom they
will pay their spenddown amount.
new text end