1.1 	A bill for an act
1.2 	relating to human services; adding registered nurse evaluations as a covered home 
1.3 	care service under medical assistance; amending Minnesota Statutes 2016, sections 
1.4 	256B.0651, subdivisions 1, 2; 256B.0652, subdivisions 3a, 11; 256B.85, subdivision 
1.5 	8; Minnesota Statutes 2017 Supplement, sections 256B.0653, subdivisions 2, 6; 
1.6 	256B.0915, subdivision 3a.
1.7 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.8 	Section 1. Minnesota Statutes 2016, section 256B.0651, subdivision 1, is amended to read:
1.9 		Subdivision 1.Definitions. (a) For the purposes of sections 256B.0651 to 256B.0654
1.10 	and 256B.0659, the terms in paragraphs (b) to (g) have the meanings given.
1.11 	(b) "Activities of daily living" has the meaning given in section 256B.0659, subdivision 
1.12 	1, paragraph (b).
1.13 	(c) "Assessment" means a review and evaluation of a recipient's need for home care 
1.14 	services conducted in person.
1.15 	(d) "Home care services" means medical assistance covered services that are home health 
1.16 	agency services, including skilled nurse visits; home health aide visits; physical therapy, 
1.17 	occupational therapy, respiratory therapy, and language-speech pathology therapy; home 
1.18 	care nursing; and personal care assistance.
1.19 	(e) "Home residence," effective January 1, 2010, means a residence owned or rented by 
1.20 	the recipient either alone, with roommates of the recipient's choosing, or with an unpaid 
1.21 	responsible party or legal representative; or a family foster home where the license holder 
1.22 	lives with the recipient and is not paid to provide home care services for the recipient except 
1.23 	as allowed under sections 256B.0652, subdivision 10, and 256B.0654, subdivision 4.
2.1 	(f) "Medically necessary" has the meaning given in Minnesota Rules, parts 9505.0170
2.2 	to 9505.0475.
2.3 	(g) "Registered nurse evaluation" means a face-to-face assessment of a person by a 
2.4 	registered nurse employed by a home care nursing agency to determine the person's need 
2.5 	for additional home care nursing.
2.6 	(h) "Ventilator-dependent" means an individual who receives mechanical ventilation 
2.7 	for life support at least six hours per day and is expected to be or has been dependent on a 
2.8 	ventilator for at least 30 consecutive days.

2.9 	Sec. 2. Minnesota Statutes 2016, section 256B.0651, subdivision 2, is amended to read:
2.10 		Subd. 2.Services covered. Home care services covered under this section and sections 
2.11 	256B.0652 to 256B.0654 and 256B.0659 include:
2.12 	(1) registered nurse evaluation under subdivision 1, paragraph (g);
2.13 	(2) nursing services under sections 256B.0625, subdivision 6a, and 256B.0653;
2.14 	(2) (3) home care nursing services under sections 256B.0625, subdivision 7, and 
2.15 	256B.0654;
2.16 	(3) (4) home health services under sections 256B.0625, subdivision 6a, and 256B.0653;
2.17 	(4) (5) personal care assistance services under sections 256B.0625, subdivision 19a, and 
2.18 	256B.0659;
2.19 	(5) (6) supervision of personal care assistance services provided by a qualified 
2.20 	professional under sections 256B.0625, subdivision 19a, and 256B.0659;
2.21 	(6) (7) face-to-face assessments by county public health nurses for services under sections 
2.22 	256B.0625, subdivision 19a, and 256B.0659; and
2.23 	(7) (8) service updates and review of temporary increases for personal care assistance 
2.24 	services by the county public health nurse for services under sections 256B.0625, subdivision 
2.25 	19a, and 256B.0659.

2.26 	Sec. 3. Minnesota Statutes 2016, section 256B.0652, subdivision 3a, is amended to read:
2.27 		Subd. 3a. Authorization; generally. The commissioner, or the commissioner's designee, 
2.28 	shall review the assessment, request for temporary services, service plan, registered nurse 
2.29 	evaluation, and any additional information that is submitted. The commissioner shall, within 
3.1 	30 days after receiving a complete request, assessment, and service plan, authorize home 
3.2 	care services as provided in this section.

3.3 	Sec. 4. Minnesota Statutes 2016, section 256B.0652, subdivision 11, is amended to read:
3.4 		Subd. 11.Limits on services without authorization. A recipient may receive the 
3.5 	following home care services during a calendar year:
3.6 	(1) up to two face-to-face assessments to determine a recipient's need for personal care 
3.7 	assistance services;
3.8 	(2) one service update done to determine a recipient's need for personal care assistance 
3.9 	services; and
3.10 	(3) up to nine face-to-face skilled nurse visits;
3.11 	(4) one assessment per each home health agency; and
3.12 	(5) one registered nurse evaluation per each home care agency.

3.13 	Sec. 5. Minnesota Statutes 2017 Supplement, section 256B.0653, subdivision 2, is amended 
3.14 	to read:
3.15 		Subd. 2.Definitions. For the purposes of this section, the following terms have the 
3.16 	meanings given.
3.17 	(a) "Assessment" means an evaluation of the recipient's medical need for home health 
3.18 	agency services by a registered nurse or appropriate therapist that is conducted within 30 
3.19 	days of a request.
3.20 	(b) "Home care therapies" means occupational, physical, and respiratory therapy and 
3.21 	speech-language pathology services provided in the home by a Medicare certified home 
3.22 	health agency.
3.23 	(c) "Home health agency services" means the assessment defined in paragraph (a) when 
3.24 	conducted to determine the need for a skilled nurse visit or home health aide and services 
3.25 	delivered by a home health agency to a recipient with medical needs due to illness, disability, 
3.26 	or physical conditions in settings permitted under section 256B.0625, subdivision 6a.
3.27 	(d) "Home health aide" means an employee of a home health agency who completes 
3.28 	medically oriented tasks written in the plan of care for a recipient.
3.29 	(e) "Home health agency" means a home care provider agency that is Medicare-certified.
4.1 	(f) "Occupational therapy services" mean the services defined in Minnesota Rules, part 
4.2 	9505.0390.
4.3 	(g) "Physical therapy services" mean the services defined in Minnesota Rules, part 
4.4 	9505.0390.
4.5 	(h) "Respiratory therapy services" mean the services defined in chapter 147C.
4.6 	(i) "Speech-language pathology services" mean the services defined in Minnesota Rules, 
4.7 	part 9505.0390.
4.8 	(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks 
4.9 	required due to a recipient's medical condition that can only be safely provided by a 
4.10 	professional nurse to restore and maintain optimal health.
4.11 	(k) "Store-and-forward technology" means telehomecare services that do not occur in 
4.12 	real time via synchronous transmissions such as diabetic and vital sign monitoring.
4.13 	(l) "Telehomecare" means the use of telecommunications technology via live, two-way 
4.14 	interactive audiovisual technology which may be augmented by store-and-forward 
4.15 	technology.
4.16 	(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to deliver 
4.17 	a skilled nurse visit to a recipient located at a site other than the site where the nurse is 
4.18 	located and is used in combination with face-to-face skilled nurse visits to adequately meet 
4.19 	the recipient's needs.

4.20 	Sec. 6. Minnesota Statutes 2017 Supplement, section 256B.0653, subdivision 6, is amended 
4.21 	to read:
4.22 		Subd. 6.Noncovered home health agency services. The following are not eligible for 
4.23 	payment under medical assistance as a home health agency service:
4.24 	(1) telehomecare skilled nurses services that is communication between the home care 
4.25 	nurse and recipient that consists solely of a telephone conversation, facsimile, electronic 
4.26 	mail, or a consultation between two health care practitioners;
4.27 	(2) the following skilled nurse visits:
4.28 	(i) for the purpose of monitoring medication compliance with an established medication 
4.29 	program for a recipient;
4.30 	(ii) administering or assisting with medication administration, including injections, 
4.31 	prefilling syringes for injections, or oral medication setup of an adult recipient, when, as 
5.1 	determined and documented by the registered nurse, the need can be met by an available 
5.2 	pharmacy or the recipient or a family member is physically and mentally able to 
5.3 	self-administer or prefill a medication;
5.4 	(iii) services done for the sole purpose of supervision of the home health aide or personal 
5.5 	care assistant;
5.6 	(iv) services done for the sole purpose to train other home health agency workers;
5.7 	(v) services done for the sole purpose of blood samples or lab draw when the recipient 
5.8 	is able to access these services outside the home; and
5.9 	(vi) Medicare evaluation or administrative nursing visits required by Medicare with the 
5.10 	exception of the assessment referenced in subdivision 2, paragraph (c);
5.11 	(3) home health aide visits when the following activities are the sole purpose for the 
5.12 	visit: companionship, socialization, household tasks, transportation, and education;
5.13 	(4) home care therapies provided in other settings such as a clinic or as an inpatient or 
5.14 	when the recipient can access therapy outside of the recipient's residence; and
5.15 	(5) home health agency services without qualifying documentation of a face-to-face 
5.16 	encounter as specified in subdivision 7.

5.17 	Sec. 7. Minnesota Statutes 2017 Supplement, section 256B.0915, subdivision 3a, is 
5.18 	amended to read:
5.19 		Subd. 3a.Elderly waiver cost limits. (a) Effective on the first day of the state fiscal 
5.20 	year in which the resident assessment system as described in section 256R.17 for nursing 
5.21 	home rate determination is implemented and the first day of each subsequent state fiscal 
5.22 	year, the monthly limit for the cost of waivered services to an individual elderly waiver 
5.23 	client shall be the monthly limit of the case mix resident class to which the waiver client 
5.24 	would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the 
5.25 	last day of the previous state fiscal year, adjusted by any legislatively adopted home and 
5.26 	community-based services percentage rate adjustment. If a legislatively authorized increase 
5.27 	is service-specific, the monthly cost limit shall be adjusted based on the overall average 
5.28 	increase to the elderly waiver program.
5.29 	(b) The monthly limit for the cost of waivered services under paragraph (a) to an 
5.30 	individual elderly waiver client assigned to a case mix classification A with:
5.31 	(1) no dependencies in activities of daily living; or
6.1 	(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when 
6.2 	the dependency score in eating is three or greater as determined by an assessment performed 
6.3 	under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new 
6.4 	participants enrolled in the program on or after July 1, 2011. This monthly limit shall be 
6.5 	applied to all other participants who meet this criteria at reassessment. This monthly limit 
6.6 	shall be increased annually as described in paragraphs (a) and (e).
6.7 	(c) If extended medical supplies and equipment or environmental modifications are or 
6.8 	will be purchased for an elderly waiver client, the costs may be prorated for up to 12 
6.9 	consecutive months beginning with the month of purchase. If the monthly cost of a recipient's 
6.10 	waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e), 
6.11 	the annual cost of all waivered services shall be determined. In this event, the annual cost 
6.12 	of all waivered services shall not exceed 12 times the monthly limit of waivered services 
6.13 	as described in paragraph (a), (b), (d), or (e).
6.14 	(d) Effective July 1, 2013, the monthly cost limit of waiver services, including any 
6.15 	necessary home care services described in section 256B.0651, subdivision 2, for individuals 
6.16 	who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1, 
6.17 	paragraph (g) (h), shall be the average of the monthly medical assistance amount established 
6.18 	for home care services as described in section 256B.0652, subdivision 7, and the annual 
6.19 	average contracted amount established by the commissioner for nursing facility services 
6.20 	for ventilator-dependent individuals. This monthly limit shall be increased annually as 
6.21 	described in paragraphs (a) and (e).
6.22 	(e) Effective January 1, 2018, and each January 1 thereafter, the monthly cost limits for 
6.23 	elderly waiver services in effect on the previous December 31 shall be increased by the 
6.24 	difference between any legislatively adopted home and community-based provider rate 
6.25 	increases effective on January 1 or since the previous January 1 and the average statewide 
6.26 	percentage increase in nursing facility operating payment rates under chapter 256R, effective 
6.27 	the previous January 1. This paragraph shall only apply if the average statewide percentage 
6.28 	increase in nursing facility operating payment rates is greater than any legislatively adopted 
6.29 	home and community-based provider rate increases effective on January 1, or occurring 
6.30 	since the previous January 1.

6.31 	Sec. 8. Minnesota Statutes 2016, section 256B.85, subdivision 8, is amended to read:
6.32 		Subd. 8.Determination of CFSS service authorization amount. (a) All community 
6.33 	first services and supports must be authorized by the commissioner or the commissioner's 
6.34 	designee before services begin. The authorization for CFSS must be completed as soon as 
7.1 	possible following an assessment but no later than 40 calendar days from the date of the 
7.2 	assessment.
7.3 	(b) The amount of CFSS authorized must be based on the participant's home care rating 
7.4 	described in paragraphs (d) and (e) and any additional service units for which the participant 
7.5 	qualifies as described in paragraph (f).
7.6 	(c) The home care rating shall be determined by the commissioner or the commissioner's 
7.7 	designee based on information submitted to the commissioner identifying the following for 
7.8 	a participant:
7.9 	(1) the total number of dependencies of activities of daily living;
7.10 	(2) the presence of complex health-related needs; and
7.11 	(3) the presence of Level I behavior.
7.12 	(d) The methodology to determine the total service units for CFSS for each home care 
7.13 	rating is based on the median paid units per day for each home care rating from fiscal year 
7.14 	2007 data for the PCA program.
7.15 	(e) Each home care rating is designated by the letters P through Z and EN and has the 
7.16 	following base number of service units assigned:
7.17 	(1) P home care rating requires Level I behavior or one to three dependencies in ADLs 
7.18 	and qualifies the person for five service units;
7.19 	(2) Q home care rating requires Level I behavior and one to three dependencies in ADLs 
7.20 	and qualifies the person for six service units;
7.21 	(3) R home care rating requires a complex health-related need and one to three 
7.22 	dependencies in ADLs and qualifies the person for seven service units;
7.23 	(4) S home care rating requires four to six dependencies in ADLs and qualifies the person 
7.24 	for ten service units;
7.25 	(5) T home care rating requires four to six dependencies in ADLs and Level I behavior 
7.26 	and qualifies the person for 11 service units;
7.27 	(6) U home care rating requires four to six dependencies in ADLs and a complex 
7.28 	health-related need and qualifies the person for 14 service units;
7.29 	(7) V home care rating requires seven to eight dependencies in ADLs and qualifies the 
7.30 	person for 17 service units;
8.1 	(8) W home care rating requires seven to eight dependencies in ADLs and Level I 
8.2 	behavior and qualifies the person for 20 service units;
8.3 	(9) Z home care rating requires seven to eight dependencies in ADLs and a complex 
8.4 	health-related need and qualifies the person for 30 service units; and
8.5 	(10) EN home care rating includes ventilator dependency as defined in section 256B.0651, 
8.6 	subdivision 1, paragraph (g) (h). A person who meets the definition of ventilator-dependent 
8.7 	and the EN home care rating and utilize a combination of CFSS and home care nursing 
8.8 	services is limited to a total of 96 service units per day for those services in combination. 
8.9 	Additional units may be authorized when a person's assessment indicates a need for two 
8.10 	staff to perform activities. Additional time is limited to 16 service units per day.
8.11 	(f) Additional service units are provided through the assessment and identification of 
8.12 	the following:
8.13 	(1) 30 additional minutes per day for a dependency in each critical activity of daily 
8.14 	living;
8.15 	(2) 30 additional minutes per day for each complex health-related need; and
8.16 	(3) 30 additional minutes per day when the behavior requires assistance at least four 
8.17 	times per week for one or more of the following behaviors:
8.18 	(i) level I behavior;
8.19 	(ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior; 
8.20 	or
8.21 	(iii) increased need for assistance for participants who are verbally aggressive or resistive 
8.22 	to care so that the time needed to perform activities of daily living is increased.
8.23 	(g) The service budget for budget model participants shall be based on:
8.24 	(1) assessed units as determined by the home care rating; and
8.25 	(2) an adjustment needed for administrative expenses.