HF 1998

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; making changes to continuing care provisions;
modifying long-term care facilities; modifying medical assistance federal
screening requirements; allowing the commissioner to withhold certain
payments, penalties, and interest for delinquent payments; changing medical
assistance eligibility requirements; changing medical assistance coverage for
alternative care; providing case management services; amending the Medicaid
waiver for elderly services; requiring reports; providing penalties; amending
Minnesota Statutes 2006, sections 256.9741, subdivisions 1, 3; 256.9742,
subdivisions 3, 4, 6; 256B.0911, subdivisions 4b, 6, 7, by adding a subdivision;
256B.0913, subdivisions 4, 5a; 256B.0915; repealing Minnesota Statutes 2006,
section 256.9743; Minnesota Rules, part 9505.0335.

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

Section 1.

Minnesota Statutes 2006, section 256.9741, subdivision 1, is amended to
read:

Subdivision 1.

Long-term care facility.

"Long-term care facility" means a nursing
home licensed under sections 144A.02 to 144A.10 deleted text begin or deleted text end new text begin ; a new text end boarding care home licensed
under sections 144.50 to 144.56 new text begin ; or a licensed or registered residential setting which
provides or arranges for the provision of home care services new text end .

Sec. 2.

Minnesota Statutes 2006, section 256.9741, subdivision 3, is amended to read:

Subd. 3.

Client.

"Client" means an individual who requests, or on whose behalf a
request is made for, ombudsman services and is (a) a resident of a long-term care facility
or (b) a Medicare beneficiary who requests assistance relating to access, discharge, or
denial of inpatient or outpatient services, or (c) an individual reserving new text begin , receiving, new text end or
requesting a home care service.

Sec. 3.

Minnesota Statutes 2006, section 256.9742, subdivision 3, is amended to read:

Subd. 3.

Posting.

Every long-term care facility and acute care facility shall post in a
conspicuous place the address and telephone number of the office. A home care service
provider shall provide all recipients, including those in deleted text begin elderly deleted text end housing with services
under chapter 144D, with the address and telephone number of the office. Counties shall
provide clients receiving deleted text begin a consumer support grant or a service allowance deleted text end new text begin long-term care
consultation services under section 256B.0911 or home and community-based services
through a state or federally funded program new text end with the name, address, and telephone number
of the office. The posting or notice is subject to approval by the ombudsman.

Sec. 4.

Minnesota Statutes 2006, section 256.9742, subdivision 4, is amended to read:

Subd. 4.

Access to long-term care and acute care facilities and clients.

The
ombudsman or designee may:

(1) enter any long-term care facility without notice at any time;

(2) enter any acute care facility without notice during normal business hours;

(3) enter any acute care facility without notice at any time to interview a patient or
observe services being provided to the patient as part of an investigation of a matter that is
within the scope of the ombudsman's authority, but only if the ombudsman's or designee's
presence does not intrude upon the privacy of another patient or interfere with routine
hospital services provided to any patient in the facility;

(4) communicate privately and without restriction with any client deleted text begin in accordance
with section 144.651 deleted text end , as long as the ombudsman has the client's consent for such
communication;

(5) inspect records of a long-term care facility, home care service provider, or acute
care facility that pertain to the care of the client according to deleted text begin sections deleted text end new text begin section new text end 144.335 deleted text begin and
144.651 deleted text end ; and

(6) with the consent of a client or client's legal guardian, the ombudsman or
designated staff shall have access to review records pertaining to the care of the client
according to deleted text begin sections deleted text end new text begin section new text end 144.335 deleted text begin and 144.651 deleted text end . If a client cannot consent and has no
legal guardian, access to the records is authorized by this section.

A person who denies access to the ombudsman or designee in violation of this
subdivision or aids, abets, invites, compels, or coerces another to do so is guilty of a
misdemeanor.

Sec. 5.

Minnesota Statutes 2006, section 256.9742, subdivision 6, is amended to read:

Subd. 6.

Prohibition against discrimination or retaliation.

(a) No entity shall take
discriminatory, disciplinary, or retaliatory action against an employee or volunteer, or a
patient, resident, or guardian or family member of a patient, resident, or guardian for filing
in good faith a complaint with or providing information to the ombudsman or designee
including volunteers. A person who violates this subdivision or who aids, abets, invites,
compels, or coerces another to do so is guilty of a misdemeanor.

(b) There shall be a rebuttable presumption that any adverse action, as defined below,
within 90 days of report, is discriminatory, disciplinary, or retaliatory. For the purpose
of this clause, the term "adverse action" refers to action taken by the entity involved in a
report against the person making the report or the person with respect to whom the report
was made because of the report, and includes, but is not limited to:

(1) discharge or transfer from a facility;

(2) termination of service;

(3) restriction or prohibition of access to the facility or its residents;

(4) discharge from or termination of employment;

(5) demotion or reduction in remuneration for services; and

(6) any restriction of rights set forth in section 144.651 deleted text begin or deleted text end new text begin , new text end 144A.44 new text begin , or 144A.751 new text end .

Sec. 6.

Minnesota Statutes 2006, section 256B.0911, subdivision 4b, is amended to
read:

Subd. 4b.

Exemptions and emergency admissions.

(a) Exemptions from the
federal screening requirements outlined in subdivision 4a, paragraphs (b) and (c), are
limited to:

(1) a person who, having entered an acute care facility from a certified nursing
facility, is returning to a certified nursing facility;

(2) a person transferring from one certified nursing facility in Minnesota to another
certified nursing facility in Minnesota; and

(3) a person, 21 years of age or older, who satisfies the following criteria, as specified
in Code of Federal Regulations, title 42, section 483.106(b)(2):

(i) the person is admitted to a nursing facility directly from a hospital after receiving
acute inpatient care at the hospital;

(ii) the person requires nursing facility services for the same condition for which
care was provided in the hospital; and

(iii) the attending physician has certified before the nursing facility admission that
the person is likely to receive less than 30 days of nursing facility services.

(b) Persons who are exempt from preadmission screening for purposes of level of
care determination include:

(1) persons described in paragraph (a);

(2) an individual who has a contractual right to have nursing facility care paid for
indefinitely by the veterans' administration;

(3) an individual enrolled in a demonstration project under section 256B.69,
subdivision 8, at the time of application to a nursing facility; new text begin and new text end

(4) an individual currently being served under the alternative care program or under
a home and community-based services waiver authorized under section 1915(c) of the
federal Social Security Act deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (5) individuals admitted to a certified nursing facility for a short-term stay, which
is expected to be 14 days or less in duration based upon a physician's certification, and
who have been assessed and approved for nursing facility admission within the previous
six months. This exemption applies only if the consultation team member determines at
the time of the initial assessment of the six-month period that it is appropriate to use the
nursing facility for short-term stays and that there is an adequate plan of care for return to
the home or community-based setting. If a stay exceeds 14 days, the individual must be
referred no later than the first county working day following the 14th resident day for a
screening, which must be completed within five working days of the referral. The payment
limitations in subdivision 7 apply to an individual found at screening to not meet the level
of care criteria for admission to a certified nursing facility.
deleted text end

(c) Persons admitted to a Medicaid-certified nursing facility from the community
on an emergency basis as described in paragraph (d) or from an acute care facility on a
nonworking day must be screened the first working day after admission.

(d) Emergency admission to a nursing facility prior to screening is permitted when
all of the following conditions are met:

(1) a person is admitted from the community to a certified nursing or certified
boarding care facility during county nonworking hours;

(2) a physician has determined that delaying admission until preadmission screening
is completed would adversely affect the person's health and safety;

(3) there is a recent precipitating event that precludes the client from living safely in
the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
inability to continue to provide care;

(4) the attending physician has authorized the emergency placement and has
documented the reason that the emergency placement is recommended; and

(5) the county is contacted on the first working day following the emergency
admission.

Transfer of a patient from an acute care hospital to a nursing facility is not considered
an emergency except for a person who has received hospital services in the following
situations: hospital admission for observation, care in an emergency room without hospital
admission, or following hospital 24-hour bed care.

(e) A nursing facility must provide deleted text begin a deleted text end written deleted text begin notice to persons who satisfy the criteria
in paragraph (a), clause (3), deleted text end new text begin information to all persons admitted new text end regarding the person's
right to request and receive long-term care consultation services as defined in subdivision
1a. The deleted text begin notice deleted text end new text begin information new text end must be provided prior to the person's discharge from the
facility and in a format specified by the commissioner.

Sec. 7.

Minnesota Statutes 2006, section 256B.0911, subdivision 6, is amended to read:

Subd. 6.

Payment for long-term care consultation services.

(a) The total payment
for each county must be paid monthly by certified nursing facilities in the county. The
monthly amount to be paid by each nursing facility for each fiscal year must be determined
by dividing the county's annual allocation for long-term care consultation services by 12
to determine the monthly payment and allocating the monthly payment to each nursing
facility based on the number of licensed beds in the nursing facility. Payments to counties
in which there is no certified nursing facility must be made by increasing the payment
rate of the two facilities located nearest to the county seat.

(b) The commissioner shall include the total annual payment determined under
paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
according to section 256B.431, subdivision 2b, paragraph (g) deleted text begin , or 256B.435 deleted text end .

(c) In the event of the layaway, delicensure and decertification, or removal from
layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
the per diem payment amount in paragraph (b) and may adjust the monthly payment
amount in paragraph (a). The effective date of an adjustment made under this paragraph
shall be on or after the first day of the month following the effective date of the layaway,
delicensure and decertification, or removal from layaway.

(d) Payments for long-term care consultation services are available to the county
or counties to cover staff salaries and expenses to provide the services described in
subdivision 1a. The county shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provide long-term care consultation
services while meeting the state's long-term care outcomes and objectives as defined in
section 256B.0917, subdivision 1. The county shall be accountable for meeting local
objectives as approved by the commissioner in the biennial home and community-based
services quality assurance plan on a form provided by the commissioner.

(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.

(f) The commissioner of human services shall amend the Minnesota medical
assistance plan to include reimbursement for the local consultation teams.

(g) The county may bill, as case management services, assessments, support
planning, and follow-along provided to persons determined to be eligible for case
management under Minnesota health care programs. No individual or family member
shall be charged for an initial assessment or initial support plan development provided
under subdivision 3a or 3b.

Sec. 8.

Minnesota Statutes 2006, section 256B.0911, is amended by adding a
subdivision to read:

new text begin Subd. 6a. new text end

new text begin Withholding. new text end

new text begin If any provider obligated to pay the long-term care
consultation amount as described in subdivision 6 is more than two months delinquent in
the timely payment of the monthly installment, the commissioner may withhold payments,
penalties, and interest in accordance with the methods outlined in section 256.9657,
subdivision 7a. Any amount withheld under this provision must be returned to the county
to whom the delinquent payments were due.
new text end

Sec. 9.

Minnesota Statutes 2006, section 256B.0911, subdivision 7, is amended to read:

Subd. 7.

Reimbursement for certified nursing facilities.

(a) Medical assistance
reimbursement for nursing facilities shall be authorized for a medical assistance recipient
only if a preadmission screening has been conducted prior to admission or the county has
authorized an exemption. Medical assistance reimbursement for nursing facilities shall
not be provided for any recipient who the local screener has determined does not meet the
level of care criteria for nursing facility placement or, if indicated, has not had a level II
OBRA evaluation as required under the federal Omnibus Budget Reconciliation Act of
1987 completed unless an admission for a recipient with mental illness is approved by the
local mental health authority or an admission for a recipient with developmental disability
is approved by the state developmental disability authority.

(b) The nursing facility must not bill a person who is not a medical assistance
recipient for resident days that preceded the date of completion of screening activities as
required under subdivisions 4a, 4b, and 4c. The nursing facility must include unreimbursed
resident days in the nursing facility resident day totals reported to the commissioner.

deleted text begin (c) The commissioner shall make a request to the Centers for Medicare and Medicaid
Services for a waiver allowing team approval of Medicaid payments for certified nursing
facility care. An individual has a choice and makes the final decision between nursing
facility placement and community placement after the screening team's recommendation,
except as provided in subdivision 4a, paragraph (c).
deleted text end

Sec. 10.

Minnesota Statutes 2006, section 256B.0913, subdivision 4, is amended to
read:

Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

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

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

(2) the person is age 65 or older;

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

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

(5) the person needs services that are not funded through other state or federal
funding;

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

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

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

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

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

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

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

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

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

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

Sec. 11.

Minnesota Statutes 2006, section 256B.0913, subdivision 5a, is amended to
read:

Subd. 5a.

Services; service definitions; service standards.

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

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

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

Sec. 12.

Minnesota Statutes 2006, section 256B.0915, is amended to read:

256B.0915 MEDICAID WAIVER FOR ELDERLY SERVICES.

Subdivision 1.

Authority.

The commissioner is authorized to apply for a home
and community-based services waiver for the elderly, authorized under section 1915(c)
of the Social Security Act, in order to obtain federal financial participation to expand
the availability of services for persons who are eligible for medical assistance. The
commissioner may apply for additional waivers or pursue other federal financial
participation which is advantageous to the state for funding home care services for the
frail elderly who are eligible for medical assistance. The provision of waivered services
to elderly and disabled medical assistance recipients must comply with the criteria new text begin for
service definitions and provider standards new text end approved in the waiver.

Subd. 1a.

Elderly waiver case management services.

(a) Elderly case management
services under the home and community-based services waiver for elderly individuals are
available from providers meeting qualification requirements and the standards specified
in subdivision 1b. Eligible recipients may choose any qualified provider of elderly case
management services.

new text begin Case management services assist individuals who receive waiver services in gaining
access to needed waiver and other state plan services, as well as needed medical, social,
educational, and other services regardless of the funding source for the services to which
access is gained.
new text end

new text begin A case aide shall provide assistance to the case manager in carrying out
administrative activities of the case management function. The case aide may not assume
responsibilities that require professional judgment including assessments, reassessments,
and care plan development. The case manager is responsible for providing oversight of
the case aide.
new text end

new text begin Case managers shall be responsible for ongoing monitoring of the provision of
services included in the individual's plan of care. Case managers shall initiate and oversee
the process of assessment and reassessment of the individual's care and review plan of
care at intervals specified in the federally approved waiver plan.
new text end

(b) The county of service or tribe must provide access to and arrange for case
management services. new text begin County of service has the meaning given it in Minnesota Rules,
part 9505.0015, subpart 11.
new text end

Subd. 1b.

Provider qualifications and standards.

The commissioner must
enroll qualified providers of elderly case management services under the home
and community-based waiver for the elderly under section 1915(c) of the Social
Security Act. The enrollment process shall ensure the provider's ability to meet the
qualification requirements and standards in this subdivision and other federal and state
requirements of this service. An elderly case management provider is an enrolled medical
assistance provider who is determined by the commissioner to have all of the following
characteristics:

(1) the demonstrated capacity and experience to provide the components of
case management to coordinate and link community resources needed by the eligible
population;

(2) administrative capacity and experience in serving the target population for
whom it will provide services and in ensuring quality of services under state and federal
requirements;

(3) a financial management system that provides accurate documentation of services
and costs under state and federal requirements;

(4) the capacity to document and maintain individual case records under state and
federal requirements; and

(5) the deleted text begin county deleted text end new text begin lead agency new text end may allow a case manager employed by the deleted text begin county deleted text end new text begin lead
agency new text end to delegate certain aspects of the case management activity to another individual
employed by the deleted text begin county deleted text end new text begin lead agency new text end provided there is oversight of the individual by
the case manager. The case manager may not delegate those aspects which require
professional judgment including assessments, reassessments, and care plan development. new text begin
Lead agencies include counties, health plans, and federally recognized tribes who
authorize services under this section.
new text end

deleted text begin Subd. 1c. deleted text end

deleted text begin Case management activities under the state plan. deleted text end

deleted text begin The commissioner
shall seek an amendment to the home and community-based services waiver for the
elderly to implement the provisions of subdivisions 1a and 1b. If the commissioner
is unable to secure the approval of the secretary of health and human services for the
requested waiver amendment by December 31, 1993, the commissioner shall amend
the medical assistance state plan to provide that case management provided under the
home and community-based services waiver for the elderly is performed by counties
as an administrative function for the proper and effective administration of the state
medical assistance plan. The state shall reimburse counties for the nonfederal share of
costs for case management performed as an administrative function under the home and
community-based services waiver for the elderly.
deleted text end

Subd. 1d.

Posteligibility treatment of income and resources for elderly waiver.

Notwithstanding the provisions of section 256B.056, the commissioner shall make the
following amendment to the medical assistance elderly waiver program effective July 1,
1999, or upon federal approval, whichever is later.

A recipient's maintenance needs will be an amount equal to the Minnesota
supplemental aid equivalent rate as defined in section 256I.03, subdivision 5, plus the
medical assistance personal needs allowance as defined in section 256B.35, subdivision
1, paragraph (a), when applying posteligibility treatment of income rules to the gross
income of elderly waiver recipients, except for individuals whose income is in excess of
the special income standard according to Code of Federal Regulations, title 42, section
435.236. Recipient maintenance needs shall be adjusted under this provision each July 1.

Subd. 2.

Spousal impoverishment policies.

The commissioner shall deleted text begin seek to amend
the federal waiver and the medical assistance state plan to allow deleted text end new text begin apply:
new text end

new text begin (1) the new text end spousal impoverishment criteria as authorized under United States Code, title
42, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059 deleted text begin ,
except that the amendment shall seek to add to deleted text end new text begin ;
new text end

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

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

Subd. 3.

Limits of cases.

The number of medical assistance waiver recipients that
a deleted text begin county deleted text end new text begin lead agency new text end may serve must be allocated according to the number of medical
assistance waiver cases open on July 1 of each fiscal year. Additional recipients may be
served with the approval of the commissioner.

Subd. 3a.

Elderly waiver cost limits.

(a) The monthly limit for the cost of waivered
services to an individual elderly waiver client shall be the weighted average monthly
nursing facility rate of the case mix resident class to which the elderly waiver client would
be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's
maintenance needs allowance as described in subdivision 1d, paragraph (a), until the first
day of the state fiscal year in which the resident assessment system as described in section
256B.437 for nursing home rate determination is implemented. Effective on the first day
of the state fiscal year in which the resident assessment system as described in section
256B.437 for nursing home rate determination is implemented and the first day of each
subsequent state fiscal year, the monthly limit for the cost of waivered services to an
individual elderly waiver client shall be the rate of the case mix resident class to which the
waiver client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,
in effect on the last day of the previous state fiscal year, adjusted by the greater of any
legislatively adopted home and community-based services percentage rate increase or the
average statewide percentage increase in nursing facility payment rates.

(b) If extended medical supplies and equipment or environmental modifications are
or will be purchased for an elderly waiver client, the costs may be prorated for up to
12 consecutive months beginning with the month of purchase. If the monthly cost of a
recipient's waivered services exceeds the monthly limit established in paragraph (a), the
annual cost of all waivered services shall be determined. In this event, the annual cost of
all waivered services shall not exceed 12 times the monthly limit of waivered services as
described in paragraph (a).

Subd. 3b.

Cost limits for elderly waiver applicants who reside in a nursing
facility.

(a) For a person who is a nursing facility resident at the time of requesting a
determination of eligibility for elderly waivered services, a monthly conversion limit for
the cost of elderly waivered services may be requested. The monthly conversion limit for
the cost of elderly waiver services shall be the resident class assigned under Minnesota
Rules, parts 9549.0050 to 9549.0059, for that resident in the nursing facility where
the resident currently resides until July 1 of the state fiscal year in which the resident
assessment system as described in section 256B.437 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.437 for nursing home rate determination
is implemented, the monthly conversion limit for the cost of elderly waiver services
shall be the per diem nursing facility rate as determined by the resident assessment
system as described in section 256B.437 for that resident in the nursing facility where
the resident currently resides multiplied by 365 and divided by 12, less the recipient's
maintenance needs allowance as described in subdivision 1d. The initially approved
conversion rate may be adjusted by the greater of any subsequent legislatively adopted
home and community-based services percentage rate increase or the average statewide
percentage increase in nursing facility payment rates. The limit under this subdivision
only applies to persons discharged from a nursing facility after a minimum 30-day stay
and found eligible for waivered services on or after July 1, 1997. new text begin For conversions from the
nursing home to the elderly waiver with consumer directed community support services,
the conversion rate limit is equal to the nursing facility rate reduced by a percentage equal
to the percentage difference between the consumer directed services budget limit that
would be assigned according to the federally approved waiver plan and the corresponding
community case mix cap, but not to exceed 50 percent.
new text end

(b) The following costs must be included in determining the total monthly costs
for the waiver client:

(1) cost of all waivered services, including extended medical supplies and equipment
and environmental modifications new text begin and adaptations new text end ; and

(2) cost of skilled nursing, home health aide, and personal care services reimbursable
by medical assistance.

Subd. 3c.

Service approval and contracting provisions.

(a) Medical assistance
funding for skilled nursing services, private duty nursing, home health aide, and personal
care services for waiver recipients must be approved by the case manager and included in
the individual care plan.

(b) A deleted text begin county deleted text end new text begin lead agency new text end is not required to contract with a provider of supplies and
equipment if the monthly cost of the supplies and equipment is less than $250.

Subd. 3d.

Adult foster care rate.

The adult foster care rate shall be considered
a difficulty of care payment and shall not include room and board. The adult foster
care service rate shall be negotiated between the deleted text begin county deleted text end new text begin lead new text end agency and the foster care
provider. The elderly waiver payment for the foster care service in combination with
the payment for all other elderly waiver services, including case management, must not
exceed the limit specified in subdivision 3a, paragraph (a).

Subd. 3e.

deleted text begin Assisted living deleted text end new text begin Customized living new text end service rate.

(a) Payment for deleted text begin assisted
living service deleted text end new text begin customize living services new text end shall be a monthly rate negotiated and authorized
by the deleted text begin county agency based on an individualized service plan for each resident and may
not cover direct rent or food costs. deleted text end new text begin lead agency within the parameters established by
the commissioner. The payment agreement must delineate the services that have been
customized for each recipient and specify the amount of each service to be provided. The
lead agency shall ensure that there is a documented need for all services authorized.
Customized living services must not include rent or raw food costs. The negotiated
payment rate must be based on services to be provided. Negotiated rates must not exceed
payment rates for comparable elderly waiver or medical assistance services and must
reflect economies of scale.
new text end

(b) The individualized monthly negotiated payment for deleted text begin assisted living deleted text end new text begin customized
living new text end services deleted text begin as described in section 256B.0913, subdivisions 5d to 5f, and residential
care services as described in section 256B.0913, subdivision 5c, deleted text end shall not exceed the
nonfederal share, in effect on July 1 of the state fiscal year for which the rate limit
is being calculated, 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.437 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.437 for nursing home rate determination
is implemented and July 1 of each subsequent state fiscal year, the individualized monthly
negotiated payment for the services described in this clause shall not exceed the limit
described in this clause which was in effect on June 30 of the previous state fiscal year
and which has been adjusted by the greater of any legislatively adopted home and
community-based services cost-of-living percentage increase or any legislatively adopted
statewide percent rate increase for nursing facilities.

(c) deleted text begin The individualized monthly negotiated payment for assisted deleted text end new text begin Customized new text end living
services deleted text begin described in section 144A.4605 and deleted text end new text begin are new text end delivered by a provider licensed by the
Department of Health as a class A new text begin or class F new text end home care provider deleted text begin or an assisted living
home care provider deleted text end and provided in a building that is registered as a housing with services
establishment under chapter 144D deleted text begin and that provides 24-hour supervision in combination
with the payment for other elderly waiver services, including case management, must not
exceed the limit specified in subdivision 3a deleted text end .

Subd. 3f.

Individual service rates; expenditure forecasts.

(a) The deleted text begin county deleted text end new text begin lead
agency new text end shall negotiate individual service rates with vendors and may authorize payment
for actual costs up to the deleted text begin county's deleted text end new text begin lead agency's new text end current approved rate. Persons or agencies
must be employed by or under a contract with the deleted text begin county deleted text end new text begin lead new text end agency or the public health
nursing agency of the local board of health in order to receive funding under the elderly
waiver program, except as a provider of supplies and equipment when the monthly cost of
the supplies and equipment is less than $250.

(b) Reimbursement for the medical assistance recipients under the approved waiver
shall be made from the medical assistance account through the invoice processing
procedures of the department's Medicaid Management Information System (MMIS),
only with the approval of the client's case manager. The budget for the state share of the
Medicaid expenditures shall be forecasted with the medical assistance budget, and shall
be consistent with the approved waiver.

Subd. 3g.

Service rate limits; state assumption of costs.

(a) To improve access
to community services and eliminate payment disparities between the alternative care
program and the elderly waiver, the commissioner shall establish statewide maximum
service rate limits and eliminate deleted text begin county-specific deleted text end new text begin lead agency-specific new text end service rate limits.

(b) Effective July 1, 2001, for service rate limits, except those described or defined in
subdivisions 3d and 3e, the rate limit for each service shall be the greater of the alternative
care statewide maximum rate or the elderly waiver statewide maximum rate.

(c) deleted text begin Counties deleted text end new text begin Lead agencies new text end may negotiate individual service rates with vendors for
actual costs up to the statewide maximum service rate limit.

Subd. 4.

Termination notice.

The case manager must give the individual a ten-day
written notice of any denial, reduction, or termination of waivered services.

Subd. 5.

Assessments and reassessments for waiver clients.

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.

Subd. 6.

Implementation of care plan.

Each elderly waiver client 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 deleted text begin administering waivered
services deleted text end new text begin of service new text end when it is different than the county of financial responsibility. The
county new text begin of service new text end administering waivered services must notify the county of financial
responsibility of the approved care plan.

Subd. 7.

Prepaid elderly waiver services.

An individual for whom a prepaid health
plan is liable for nursing home services or elderly waiver services according to section
256B.69, subdivision 6a, is not eligible to new text begin also new text end receive county-administered elderly waiver
services deleted text begin under this section deleted text end .

Subd. 8.

Services and supports.

(a) Services and supports shall meet the
requirements set out in United States Code, title 42, section 1396n.

(b) Services and supports shall promote consumer choice and be arranged and
provided consistent with individualized, written care plans.

(c) The state of Minnesota, county, new text begin managed care organization, new text end or tribal government
under contract to administer the elderly waiver shall not be liable for damages, injuries,
or liabilities sustained through the purchase of direct supports or goods by the person,
the person's family, or the authorized representatives with funds received through
consumer-directed community support services under the federally approved waiver plan.
Liabilities include, but are not limited to, workers' compensation liability, the Federal
Insurance Contributions Act (FICA), or the Federal Unemployment Tax Act (FUTA).

Subd. 9.

Tribal management of elderly waiver.

Notwithstanding contrary
provisions of this section, or those in other state laws or rules, the commissioner may
develop a model for tribal management of the elderly waiver program and implement this
model through a contract between the state and any of the state's federally recognized tribal
governments. The model shall include the provision of tribal waiver case management,
assessment for personal care assistance, and administrative requirements otherwise carried
out by deleted text begin counties deleted text end new text begin lead agencies new text end but shall not include tribal financial eligibility determination
for medical assistance.

Sec. 13. new text begin REPORT; CATASTROPHIC LOSS COVERAGE.
new text end

new text begin The commissioner shall present to the legislature on January 15, 2008, a plan for
providing catastrophic loss coverage to businesses with fewer than 25 employees.
new text end

Sec. 14. new text begin REPEALER.
new text end

new text begin (a) Minnesota Statutes 2006, section 256.9743, new text end new text begin is repealed.
new text end

new text begin (b) Minnesota Rules, part 9505.0335, new text end new text begin is repealed.
new text end