1.1                          A bill for an act 
  1.2             relating to human services; provisions for long-term 
  1.3             care community services; coverage for personal care 
  1.4             services; amending Minnesota Statutes 1994, sections 
  1.5             256B.0625, subdivision 19a; 256B.0627, subdivisions 1, 
  1.6             2, 4, and 5; 256B.0628, subdivision 2; 256B.0911, 
  1.7             subdivision 2; 256B.0913, subdivisions 4, 5, 8, 12, 
  1.8             and 14; 256B.0915, subdivisions 3, 5, and by adding a 
  1.9             subdivision; and 256B.093, subdivisions 1, 2, and 3; 
  1.10            256I.03, subdivision 5, and by adding a subdivision; 
  1.11            256I.04; 256I.05, subdivisions 1, 1a, and 5; and 
  1.12            256I.06, subdivisions 2 and 6; Laws 1993, First 
  1.13            Special Session chapter 1, article 8, section 30, 
  1.14            subdivision 2. 
  1.15  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.16     Section 1.  Minnesota Statutes 1994, section 256B.0625, 
  1.17  subdivision 19a, is amended to read: 
  1.18     Subd. 19a.  [PERSONAL CARE SERVICES.] Medical assistance 
  1.19  covers personal care services in a recipient's home.  To qualify 
  1.20  for personal care services recipients who can direct their own 
  1.21  care, or persons who cannot direct their own care when 
  1.22  authorized by the responsible party, may use must be able to 
  1.23  identify their needs, direct and evaluate task accomplishment, 
  1.24  and assure their health and safety.  Approved hours may be used 
  1.25  outside the home when normal life activities take them outside 
  1.26  the home and when, without the provision of personal care, their 
  1.27  health and safety would be jeopardized.  Total hours for 
  1.28  services, whether actually performed inside or outside the 
  1.29  recipient's home, cannot exceed that which is otherwise allowed 
  1.30  for personal care services in an in-home setting according to 
  2.1   section 256B.0627.  Medical assistance does not cover personal 
  2.2   care services for residents of a hospital, nursing facility, 
  2.3   intermediate care facility, health care facility licensed by the 
  2.4   commissioner of health, or unless a resident who is otherwise 
  2.5   eligible is on leave from the facility and the facility either 
  2.6   pays for the personal care services or forgoes the facility per 
  2.7   diem for the leave days that personal care services are used 
  2.8   except as authorized in section 256B.64 for ventilator-dependent 
  2.9   recipients in hospitals.  Total hours of service and payment 
  2.10  allowed for services outside the home cannot exceed that which 
  2.11  is otherwise allowed for personal care services in an in-home 
  2.12  setting according to section 256B.0627.  All personal care 
  2.13  services must be provided according to section 256B.0627.  
  2.14  Personal care services may not be reimbursed if the personal 
  2.15  care assistant is the spouse or legal guardian of the recipient 
  2.16  or the parent of a recipient under age 18, the responsible party 
  2.17  or the foster care provider of a recipient who cannot direct the 
  2.18  recipient's own care or the recipient's legal guardian unless, 
  2.19  in the case of a foster provider, a county or state case manager 
  2.20  visits the recipient as needed, but no less than every six 
  2.21  months, to monitor the health and safety of the recipient and to 
  2.22  ensure the goals of the care plan are met.  Parents of adult 
  2.23  recipients, adult children of the recipient or adult siblings of 
  2.24  the recipient may be reimbursed for personal care services if 
  2.25  they are not the recipient's legal guardian and are granted a 
  2.26  waiver under section 256B.0627.  
  2.27     Sec. 2.  Minnesota Statutes 1994, section 256B.0627, 
  2.28  subdivision 1, is amended to read: 
  2.29     Subdivision 1.  [DEFINITION.] (a) "Home care services" 
  2.30  means a health service, determined by the commissioner as 
  2.31  medically necessary, that is ordered by a physician and 
  2.32  documented in a care plan that is reviewed by the physician at 
  2.33  least once every 60 days for the provision of home health 
  2.34  services, or private duty nursing, or at least once every 365 
  2.35  days for personal care.  Home care services are provided to the 
  2.36  recipient at the recipient's residence that is a place other 
  3.1   than a hospital or long-term care facility or as specified in 
  3.2   section 256B.0625.  
  3.3      (b) "Medically necessary" has the meaning given in 
  3.4   Minnesota Rules, parts 9505.0170 to 9505.0475.  
  3.5      (c) "Care plan" means a written description of the services 
  3.6   needed which is developed by the supervisory nurse county public 
  3.7   health nurse together with the recipient or responsible party 
  3.8   and includes a detailed description of the covered home care 
  3.9   services, who is providing the services, frequency and duration 
  3.10  of services, and expected outcomes and goals.  The provider must 
  3.11  give the recipient or responsible party recipient and the 
  3.12  recipient's choice of provider must be given a copy of the 
  3.13  completed care plan within 30 calendar days of 
  3.14  beginning following the assessment of need for home care 
  3.15  services.  
  3.16     (d) "Responsible party" means an individual residing with a 
  3.17  recipient of personal care services who is capable of providing 
  3.18  the supportive care necessary to assist the recipient to live in 
  3.19  the community, is at least 18 years old, and is not a personal 
  3.20  care assistant.  Responsible parties who are parents of minors 
  3.21  or guardians of minors or incapacitated persons may delegate the 
  3.22  responsibility to another adult during a temporary absence of at 
  3.23  least 24 hours but not more than six months.  The person 
  3.24  delegated as a responsible party must be able to meet the 
  3.25  definition of responsible party, except that the delegated 
  3.26  responsible party is required to reside with the recipient only 
  3.27  while serving as the responsible party.  Foster care license 
  3.28  holders may be designated the responsible party for residents of 
  3.29  the foster care home if case management is provided as required 
  3.30  in section 256B.0625, subdivision 19a.  For persons who, as of 
  3.31  April 1, 1992, are sharing personal care services in order to 
  3.32  obtain the availability of 24-hour coverage, an employee of the 
  3.33  personal care provider organization may be designated as the 
  3.34  responsible party if case management is provided as required in 
  3.35  section 256B.0625, subdivision 19a.  "Personal care assistant" 
  3.36  means a person who:  (1) is 18 years old; (2) is able to read, 
  4.1   write, and speak English, as well as speak the language of the 
  4.2   recipient; (3) has completed one of the training requirements as 
  4.3   specified in Minnesota Rules, part 9505.0335, subpart 3, items A 
  4.4   to D, no later than July 1, 1996; (4) has the ability to, and 
  4.5   provides covered personal care services according to the 
  4.6   recipient's care plan; (5) is not a consumer of personal care 
  4.7   services; and (6) are subject to criminal background checks. 
  4.8      (e) "Personal care provider organization" means an 
  4.9   organization enrolled to provide personal care services under 
  4.10  the medical assistance program that complies with the 
  4.11  following:  (1) owners who have a five percent interest or more 
  4.12  are subject to a criminal history check as provided in section 
  4.13  245A.04 at the time of application; (2) maintains a surety bond 
  4.14  and liability insurance throughout the duration of enrollment 
  4.15  and provides proof thereof.  The insurer must notify the 
  4.16  department of human services of the cancellation or lapse of 
  4.17  policy; and (3) maintains documentation of services as specified 
  4.18  in Minnesota Rules, part 9505.2175, subpart 7, as well as 
  4.19  evidence of compliance with PCA training requirements. 
  4.20     Sec. 3.  Minnesota Statutes 1994, section 256B.0627, 
  4.21  subdivision 2, is amended to read: 
  4.22     Subd. 2.  [SERVICES COVERED.] Home care services covered 
  4.23  under this section include:  
  4.24     (1) nursing services under section 256B.0625, subdivision 
  4.25  6a; 
  4.26     (2) private duty nursing services under section 256B.0625, 
  4.27  subdivision 7; 
  4.28     (3) home health aide services under section 256B.0625, 
  4.29  subdivision 6a; 
  4.30     (4) personal care services under section 256B.0625, 
  4.31  subdivision 19a; and 
  4.32     (5) nursing supervision of personal care services under 
  4.33  section 256B.0625, subdivision 19a; and 
  4.34     (6) assessments by county public health nurses for services 
  4.35  under section 256B.0625, subdivisions 6a, 7, and 19a.  
  4.36     Sec. 4.  Minnesota Statutes 1994, section 256B.0627, 
  5.1   subdivision 4, is amended to read: 
  5.2      Subd. 4.  [PERSONAL CARE SERVICES.] (a) The personal care 
  5.3   services that are eligible for payment are the following:  
  5.4      (1) routine bowel and bladder care; 
  5.5      (2) skin care to maintain the health of the skin, excluding 
  5.6   wound care; 
  5.7      (3) delegated therapy tasks specific to maintaining a 
  5.8   recipient's optimal level of functioning, including repetitive 
  5.9   maintenance range of motion and muscle strengthening 
  5.10  exercises specific to maintaining a recipient's level of 
  5.11  function; 
  5.12     (4) respiratory assistance; 
  5.13     (5) transfers and ambulation; 
  5.14     (6) bathing, grooming, and hairwashing necessary for 
  5.15  personal hygiene; 
  5.16     (7) turning and positioning; 
  5.17     (8) assistance with furnishing medication that is normally 
  5.18  self-administered; 
  5.19     (9) application and maintenance of prosthetics and 
  5.20  orthotics; 
  5.21     (10) cleaning medical equipment; 
  5.22     (11) dressing or undressing; 
  5.23     (12) assistance with food, nutrition, and diet 
  5.24  activities eating and meal preparation; 
  5.25     (13) accompanying a recipient to obtain medical diagnosis 
  5.26  or treatment; and 
  5.27     (14) assisting, monitoring, or prompting the recipient to 
  5.28  complete the services in clauses (1) to (13); 
  5.29     (15) redirection, monitoring, and observation that are 
  5.30  medically necessary and an integral part of completing the 
  5.31  personal cares described in clauses (1) to (14); 
  5.32     (16) redirection and intervention for behavior, including 
  5.33  observation and monitoring; 
  5.34     (17) interventions for seizure disorders including 
  5.35  monitoring and observation if the recipient has had a seizure 
  5.36  that requires intervention within the past three months; and 
  6.1      (18) incidental household services that are an integral 
  6.2   part of a personal care service described in clauses (1) to (17).
  6.3      For purposes of this subdivision, monitoring and 
  6.4   observation means watching for outward visible signs that are 
  6.5   likely to occur and for which there is a covered personal care 
  6.6   service or an appropriate personal care intervention laundry and 
  6.7   light cleaning in essential areas of the home used during 
  6.8   personal care services.  
  6.9      (b) The personal care services that are not eligible for 
  6.10  payment are the following:  
  6.11     (1) personal care services that are not in the care plan 
  6.12  developed by the supervising registered nurse in consultation 
  6.13  with the personal care assistants and the recipient or the 
  6.14  responsible party directing the care of the recipient prescribed 
  6.15  by the physician; 
  6.16     (2) assessments by personal care provider organizations or 
  6.17  by independently enrolled registered nurses; 
  6.18     (3) services that are not supervised by the registered 
  6.19  nurse in the care plan developed by the county public health 
  6.20  nurse and the recipient; 
  6.21     (3) (4) services provided by the recipient's spouse, legal 
  6.22  guardian, or parent of a minor child recipient under age 18; 
  6.23     (4) services provided by a foster care provider of a 
  6.24  recipient who cannot direct their own care, unless monitored by 
  6.25  a county or state case manager under section 256B.0625, 
  6.26  subdivision 19a; 
  6.27     (5) services provided by the residential or program license 
  6.28  holder in a residence for more than four persons; 
  6.29     (6) services that are the responsibility of a residential 
  6.30  or program license holder under the terms of a service agreement 
  6.31  and administrative rules; 
  6.32     (7) sterile procedures; 
  6.33     (8) injections of fluids into veins, muscles, or skin; 
  6.34     (9) services provided by parents of adult recipients, adult 
  6.35  children, or adult siblings of the recipient, unless these 
  6.36  relatives meet one of the following hardship criteria and the 
  7.1   commissioner waives this requirement: 
  7.2      (i) the relative resigns from a part-time or full-time job 
  7.3   to provide personal care for the recipient; 
  7.4      (ii) the relative goes from a full-time to a part-time job 
  7.5   with less compensation to provide personal care for the 
  7.6   recipient; 
  7.7      (iii) the relative takes a leave of absence without pay to 
  7.8   provide personal care for the recipient; 
  7.9      (iv) the relative incurs substantial expenses by providing 
  7.10  personal care for the recipient; or 
  7.11     (v) because of labor conditions, the relative is needed in 
  7.12  order to provide an adequate number of qualified personal care 
  7.13  assistants to meet the medical needs of the recipient; and 
  7.14     (vi) Under no circumstance may a hardship waiver be granted 
  7.15  if the relative is the recipient's legal guardian; 
  7.16     (10) homemaker services that are not an integral part of a 
  7.17  personal care services; and 
  7.18     (11)  home maintenance, or chore services, social services, 
  7.19  social activities, recreational services, educational services; 
  7.20     (12) services not specified under paragraph (a); and 
  7.21     (13) services not authorized by the commissioner or the 
  7.22  commissioner's designee. 
  7.23     Sec. 5.  Minnesota Statutes 1994, section 256B.0627, 
  7.24  subdivision 5, is amended to read: 
  7.25     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
  7.26  payments for home care services shall be limited according to 
  7.27  this subdivision.  
  7.28     (a) [EXEMPTION FROM PAYMENT LIMITATIONS.] The level, or the 
  7.29  number of hours or visits of a specific service, of home care 
  7.30  services to a recipient that began before and is continued 
  7.31  without increase on or after December 1987, shall be exempt from 
  7.32  the payment limitations of this section, as long as the services 
  7.33  are medically necessary.  
  7.34     (b) [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
  7.35  recipient may receive the following amounts of home care 
  7.36  services during a calendar year: 
  8.1      (1) a total of 40 home health aide visits or skilled nurse 
  8.2   visits under section 256B.0625, subdivision 6a; and 
  8.3      (2) up to two assessments by a supervising registered nurse 
  8.4   assessments and reassesments done by the county public health 
  8.5   nurse to determine a recipient's need for personal care 
  8.6   services, develop a care plan with the recipient, and obtain 
  8.7   prior authorization.  Additional visits may be authorized by the 
  8.8   commissioner if there are circumstances that necessitate a 
  8.9   change in provider. 
  8.10     (c) (b) [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
  8.11  services above the limits in paragraph (b) (a) must receive the 
  8.12  commissioner's prior authorization, except when: 
  8.13     (1) the home care services were required to treat an 
  8.14  emergency medical condition that if not immediately treated 
  8.15  could cause a recipient serious physical or mental disability, 
  8.16  continuation of severe pain, or death.  The provider must 
  8.17  request retroactive authorization from the county public health 
  8.18  nurse no later than five working days after giving the initial 
  8.19  service.  The provider must be able to substantiate the 
  8.20  emergency by documentation such as reports, notes, and admission 
  8.21  or discharge histories; 
  8.22     (2) the home care services were provided on or after the 
  8.23  date on which the recipient's eligibility began, but before the 
  8.24  date on which the recipient was notified that the case was 
  8.25  opened.  Authorization will be considered if the request is 
  8.26  submitted by the provider to the county public health nurse 
  8.27  within 20 working days of the date the recipient was notified 
  8.28  that the case was opened; 
  8.29     (3) a third-party payor for home care services has denied 
  8.30  or adjusted a payment.  Authorization requests must be submitted 
  8.31  by the provider to the county public health nurse within 20 
  8.32  working days of the notice of denial or adjustment.  A copy of 
  8.33  the notice must be included with the request; or 
  8.34     (4) the commissioner has determined that a county or state 
  8.35  human services agency has made an error. 
  8.36     (d) [RETROACTIVE AUTHORIZATION.] A request for retroactive 
  9.1   authorization under paragraph (c) will be evaluated according to 
  9.2   the same criteria applied to prior authorization 
  9.3   requests.  Implementation of this provision shall begin no later 
  9.4   than October 1, 1991, except that recipients who are currently 
  9.5   receiving medically necessary services above the limits 
  9.6   established under this subdivision may have a reasonable amount 
  9.7   of time to arrange for waivered services under section 256B.49 
  9.8   or to establish an alternative living arrangement.  All current 
  9.9   recipients shall be phased down to the limits established under 
  9.10  paragraph (b) on or before April 1, 1992. 
  9.11     (e) (c) [ASSESSMENT AND CARE PLAN.] The home care provider 
  9.12  county public health nurse shall conduct initially, and at least 
  9.13  annually thereafter, a face-to-face assessment of the recipient 
  9.14  and complete a care plan with the recipient using forms 
  9.15  specified by the commissioner.  For the recipient to receive, or 
  9.16  continue to receive, home care services, the provider must 
  9.17  submit evidence necessary for the commissioner to determine the 
  9.18  medical necessity of the home care services.  The provider 
  9.19  county public health nurse shall submit to the commissioner the 
  9.20  assessment, the care plan, and other information necessary to 
  9.21  determine medical necessity such as diagnostic or testing 
  9.22  information, social or medical histories, and hospital or 
  9.23  facility discharge summaries.  
  9.24     (1) The amount and type of service authorized based upon 
  9.25  the assessment and care plan will follow the recipient if the 
  9.26  recipient chooses to change providers.  
  9.27     (2) If the recipient's medical need changes, the 
  9.28  recipient's provider may assess the need for a change in service 
  9.29  authorization and request the change from the county public 
  9.30  health nurse.  The public health nurse will determine whether to 
  9.31  request the change in services based upon the provider 
  9.32  assessment, or conduct a home visit to assess the need and 
  9.33  determine whether the change is appropriate.  
  9.34     (3) To continue to receive home care services when the 
  9.35  recipient displays no significant change, the supervising nurse 
  9.36  county public health nurse has the option to review with the 
 10.1   commissioner, or the commissioner's designee, the care plan on 
 10.2   record and receive authorization for up to an additional 12 
 10.3   months. 
 10.4      (f) (d) [PRIOR AUTHORIZATION.] The commissioner, or the 
 10.5   commissioner's designee, shall review the assessment, the care 
 10.6   plan, and any additional information that is submitted.  The 
 10.7   commissioner shall, within 30 days after receiving a complete 
 10.8   request, assessment, and care plan, authorize home care services 
 10.9   as follows:  
 10.10     (1)  [HOME HEALTH SERVICES.] All home health services 
 10.11  provided by a nurse or a home health aide that exceed the limits 
 10.12  established in paragraph (b) (a) must be prior authorized by the 
 10.13  commissioner or the commissioner's designee.  Prior 
 10.14  authorization must be based on medical necessity and 
 10.15  cost-effectiveness when compared with other care options.  When 
 10.16  home health services are used in combination with personal care 
 10.17  and private duty nursing, the cost of all home care services 
 10.18  shall be considered for cost-effectiveness.  The commissioner 
 10.19  shall limit nurse and home health aide visits to no more than 
 10.20  one visit each per day. 
 10.21     (2)  [PERSONAL CARE SERVICES.] (i) All personal care 
 10.22  services and registered nurse supervision must be prior 
 10.23  authorized by the commissioner or the commissioner's designee 
 10.24  except for the limits on supervision assessments established in 
 10.25  paragraph (b) (a).  The amount of personal care services 
 10.26  authorized must be based on the recipient's home care rating.  A 
 10.27  child may not be found to be dependent in an activity of daily 
 10.28  living if because of the child's age an adult would either 
 10.29  perform the activity for the child or assist the child with the 
 10.30  activity and the amount of assistance needed is similar to the 
 10.31  assistance appropriate for a typical child of the same age.  
 10.32  Based on medical necessity, the commissioner may authorize: 
 10.33     (A) up to two 1-1/2 times the average number of direct care 
 10.34  hours provided in nursing facilities for the recipient's 
 10.35  comparable case mix level; or 
 10.36     (B) up to three 2-1/4 times the average number of direct 
 11.1   care hours provided in nursing facilities for recipients who 
 11.2   have complex medical needs or are dependent in at least seven 
 11.3   activities of daily living and need physical assistance with 
 11.4   eating or have a neurological diagnosis but in no case shall the 
 11.5   dollar amount authorized exceed the statewide weighted average 
 11.6   nursing facility payment rate for fiscal year 1995; or 
 11.7      (C) up to 60 percent of the average reimbursement rate, as 
 11.8   of July 1, 1991, plus any inflation adjustment provided, for 
 11.9   care provided in a regional treatment center for recipients who 
 11.10  have Level I behavior; or 
 11.11     (D) up to the amount the commissioner would pay, as of July 
 11.12  1, 1991, plus any inflation adjustment provided for home care 
 11.13  services, for care provided in a regional treatment center for 
 11.14  recipients referred to the commissioner by a regional treatment 
 11.15  center preadmission evaluation team.  For purposes of this 
 11.16  clause, home care services means all services provided in the 
 11.17  home or community that would be included in the payment to a 
 11.18  regional treatment center; or 
 11.19     (E) (D) up to the amount medical assistance would reimburse 
 11.20  for facility care for recipients referred to the commissioner by 
 11.21  a preadmission screening team established under section 
 11.22  256B.0911 or 256B.092; and 
 11.23     (F) (E) a reasonable amount of time for the necessary 
 11.24  provision of nursing supervision of personal care services.  
 11.25     (ii) The number of direct care hours shall be determined 
 11.26  according to the annual cost report submitted to the department 
 11.27  by nursing facilities.  The average number of direct care hours, 
 11.28  as established by May 1, 1992 for the report year 1993, as 
 11.29  established by July 11, 1994, shall be calculated and 
 11.30  incorporated into the home care limits on July 1, 1992 1995.  
 11.31  These limits shall be calculated to the nearest quarter hour. 
 11.32     (iii) The home care rating shall be determined by the 
 11.33  commissioner or the commissioner's designee based on information 
 11.34  submitted to the commissioner by the personal care provider 
 11.35  county public health nurse on forms specified by the 
 11.36  commissioner.  The home care rating shall be a combination of 
 12.1   current assessment tools developed under sections 256B.0911 and 
 12.2   256B.501 with an addition for seizure activity that will assess 
 12.3   the frequency and severity of seizure activity and with 
 12.4   adjustments, additions, and clarifications that are necessary to 
 12.5   reflect the needs and conditions of children and nonelderly 
 12.6   adults recipients who need home care.  The commissioner shall 
 12.7   establish these forms and protocols under this section and shall 
 12.8   use the advisory group established in section 256B.04, 
 12.9   subdivision 16, for consultation in establishing the forms and 
 12.10  protocols by October 1, 1991. 
 12.11     (iv) A recipient shall qualify as having complex medical 
 12.12  needs if the care required is difficult to perform and because 
 12.13  of recipient's medical condition requires more time than 
 12.14  community-based standards allow or requires more skill than 
 12.15  would ordinarily be required and the recipient needs or has one 
 12.16  or more of the following: 
 12.17     (A) daily tube feedings; 
 12.18     (B) daily parenteral therapy; 
 12.19     (C) wound or decubiti care; 
 12.20     (D) postural drainage, percussion, nebulizer treatments, 
 12.21  suctioning, tracheotomy care, oxygen, mechanical ventilation; 
 12.22     (E) catheterization; 
 12.23     (F) ostomy care; 
 12.24     (G) quadriplegia; or 
 12.25     (H) other comparable medical conditions or treatments the 
 12.26  commissioner determines would otherwise require institutional 
 12.27  care. 
 12.28     (v) A recipient shall qualify as having Level I behavior if 
 12.29  there is reasonable supporting evidence that the recipient 
 12.30  exhibits, or that without supervision, observation, or 
 12.31  redirection would exhibit, one or more of the following 
 12.32  behaviors that cause, or have the potential to cause: 
 12.33     (A) injury to his or her own body; 
 12.34     (B) physical injury to other people; or 
 12.35     (C) destruction of property. 
 12.36     (vi) Time authorized for personal care relating to Level I 
 13.1   behavior in subclause (v), items (A) to (C), shall be based on 
 13.2   the predictability, frequency, and amount of intervention 
 13.3   required. 
 13.4      (vii) A recipient shall qualify as having Level II behavior 
 13.5   if the recipient exhibits on a daily basis one or more of the 
 13.6   following behaviors that interfere with the completion of 
 13.7   personal care services under subdivision 4, paragraph (a): 
 13.8      (A) unusual or repetitive habits; 
 13.9      (B) withdrawn behavior; or 
 13.10     (C) offensive behavior. 
 13.11     (viii) A recipient with a home care rating of Level II 
 13.12  behavior in subclause (vii), items (A) to (C), shall be rated as 
 13.13  comparable to a recipient with complex medical needs under 
 13.14  subclause (iv).  If a recipient has both complex medical needs 
 13.15  and Level II behavior, the home care rating shall be the next 
 13.16  complex category up to the maximum rating under subclause (i), 
 13.17  item (B). 
 13.18     (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
 13.19  nursing services shall be prior authorized by the commissioner 
 13.20  or the commissioner's designee.  Prior authorization for private 
 13.21  duty nursing services shall be based on medical necessity and 
 13.22  cost-effectiveness when compared with alternative care options.  
 13.23  The commissioner may authorize medically necessary private duty 
 13.24  nursing services in quarter-hour units when: 
 13.25     (i) the recipient requires more individual and continuous 
 13.26  care than can be provided during a nurse visit; or 
 13.27     (ii) the cares are outside of the scope of services that 
 13.28  can be provided by a home health aide or personal care assistant.
 13.29     The commissioner may authorize: 
 13.30     (A) up to two times the average amount of direct care hours 
 13.31  provided in nursing facilities statewide for case mix 
 13.32  classification "K" as established by the annual cost report 
 13.33  submitted to the department by nursing facilities in May 1992; 
 13.34     (B) private duty nursing in combination with other home 
 13.35  care services up to the total cost allowed under clause (2); 
 13.36     (C) up to 16 hours per day if the recipient requires more 
 14.1   nursing than the maximum number of direct care hours as 
 14.2   established in item (A) and the recipient meets the hospital 
 14.3   admission criteria established under Minnesota Rules, parts 
 14.4   9505.0500 to 9505.0540.  
 14.5      The commissioner may authorize up to 16 hours per day of 
 14.6   medically necessary private duty nursing services or up to 24 
 14.7   hours per day of medically necessary private duty nursing 
 14.8   services until such time as the commissioner is able to make a 
 14.9   determination of eligibility for recipients who are 
 14.10  cooperatively applying for home care services under the 
 14.11  community alternative care program developed under section 
 14.12  256B.49, or until it is determined by the appropriate regulatory 
 14.13  agency that a health benefit plan is or is not required to pay 
 14.14  for appropriate medically necessary health care services.  
 14.15  Recipients or their representatives must cooperatively assist 
 14.16  the commissioner in obtaining this determination.  Recipients 
 14.17  who are eligible for the community alternative care program may 
 14.18  not receive more hours of nursing under this section than would 
 14.19  otherwise be authorized under section 256B.49. 
 14.20     (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
 14.21  ventilator-dependent, the monthly medical assistance 
 14.22  authorization for home care services shall not exceed what the 
 14.23  commissioner would pay for care at the highest cost hospital 
 14.24  designated as a long-term hospital under the Medicare program.  
 14.25  For purposes of this clause, home care services means all 
 14.26  services provided in the home that would be included in the 
 14.27  payment for care at the long-term hospital.  
 14.28  "Ventilator-dependent" means an individual who receives 
 14.29  mechanical ventilation for life support at least six hours per 
 14.30  day and is expected to be or has been dependent for at least 30 
 14.31  consecutive days.  
 14.32     (g) (e) [PRIOR AUTHORIZATION; TIME LIMITS.] The 
 14.33  commissioner or the commissioner's designee shall determine the 
 14.34  time period for which a prior authorization shall be effective. 
 14.35  If the recipient continues to require home care services beyond 
 14.36  the duration of the prior authorization, the home care provider 
 15.1   must request a new prior authorization through the process 
 15.2   described above county public health nurse.  Under no 
 15.3   circumstances, other than the exceptions in subdivision 5, 
 15.4   paragraph (c) (b), shall a prior authorization be valid prior to 
 15.5   the date the commissioner receives the request or for more than 
 15.6   12 months.  A recipient who appeals a reduction in previously 
 15.7   authorized home care services may continue previously authorized 
 15.8   services, other than temporary services under paragraph (i) (g), 
 15.9   pending an appeal under section 256.045.  The commissioner must 
 15.10  provide a detailed explanation of why the authorized services 
 15.11  are reduced in amount from those requested by the home care 
 15.12  provider.  
 15.13     (h) (f) [APPROVAL OF HOME CARE SERVICES.] The commissioner 
 15.14  or the commissioner's designee shall determine the medical 
 15.15  necessity of home care services, the level of caregiver 
 15.16  according to subdivision 2, and the institutional comparison 
 15.17  according to this subdivision, the cost-effectiveness of 
 15.18  services, and the amount, scope, and duration of home care 
 15.19  services reimbursable by medical assistance, based on the 
 15.20  assessment, the care plan, the recipient's age, the cost of 
 15.21  services, the recipient's medical condition, and diagnosis or 
 15.22  disability.  The commissioner may publish additional criteria 
 15.23  for determining medical necessity according to section 256B.04. 
 15.24     (i) (g) [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
 15.25  Providers The county public health nurse may request a temporary 
 15.26  authorization for home care services by telephone.  The 
 15.27  commissioner may approve a temporary level of home care services 
 15.28  based on the assessment and care plan information provided by an 
 15.29  appropriately licensed nurse.  Authorization for a temporary 
 15.30  level of home care services is limited to the time specified by 
 15.31  the commissioner, but shall not exceed 45 days.  The level of 
 15.32  services authorized under this provision shall have no bearing 
 15.33  on a future prior authorization. 
 15.34     (j) (h) [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE 
 15.35  SETTING.] Home care services provided in an adult or child 
 15.36  foster care setting must receive prior authorization by the 
 16.1   department according to the limits established in 
 16.2   paragraph (b) (a). 
 16.3      The commissioner may not authorize: 
 16.4      (1) home care services that are the responsibility of the 
 16.5   foster care provider under the terms of the foster care 
 16.6   placement agreement and administrative rules; 
 16.7      (2) personal care services when the foster care license 
 16.8   holder is also the personal care provider or personal care 
 16.9   assistant unless the recipient can direct the recipient's own 
 16.10  care, or case management is provided as required in section 
 16.11  256B.0625, subdivision 19a; 
 16.12     (3) personal care services when the responsible party is an 
 16.13  employee of, or under contract with, or has any direct or 
 16.14  indirect financial relationship with the personal care provider 
 16.15  or personal care assistant, unless case management is provided 
 16.16  as required in section 256B.0625, subdivision 19a; 
 16.17     (4) home care services when the number of foster care 
 16.18  residents is greater than four unless the county responsible for 
 16.19  the recipient's foster placement made the placement prior to 
 16.20  April 1, 1992, requests that home care services be provided, and 
 16.21  case management is provided as required in section 256B.0625, 
 16.22  subdivision 19a; or 
 16.23     (5) (3) home care services when combined with foster care 
 16.24  payments, other than room and board payments plus the cost of 
 16.25  home and community-based waivered services unless the costs of 
 16.26  home care services and waivered services are combined and 
 16.27  managed under the waiver program, that exceed the total amount 
 16.28  that public funds would pay for the recipient's care in a 
 16.29  medical institution.  
 16.30     Sec. 6.  Minnesota Statutes 1994, section 256B.0628, 
 16.31  subdivision 2, is amended to read: 
 16.32     Subd. 2.  [DUTIES.] (a) The commissioner may contract with 
 16.33  or employ qualified registered nurses and necessary support 
 16.34  staff, or contract with qualified agencies, to provide home care 
 16.35  prior authorization and review services for medical assistance 
 16.36  recipients who are receiving home care services. 
 17.1      (b) Reimbursement for the prior authorization function 
 17.2   shall be made through the medical assistance administrative 
 17.3   authority.  The state shall pay the nonfederal share.  The 
 17.4   functions will be to: 
 17.5      (1) assess the recipient's individual need for services 
 17.6   required to be cared for safely in the community; 
 17.7      (2) ensure that a care plan that meets the recipient's 
 17.8   needs is developed by the appropriate agency or individual; 
 17.9      (3) ensure cost-effectiveness of medical assistance home 
 17.10  care services; 
 17.11     (4) recommend the approval or denial of the use of medical 
 17.12  assistance funds to pay for home care services when home care 
 17.13  services exceed thresholds established by the commissioner under 
 17.14  Minnesota Rules, parts 9505.0170 to 9505.0475; 
 17.15     (5) reassess the recipient's need for and level of home 
 17.16  care services at a frequency determined by the commissioner; and 
 17.17     (6) conduct on-site assessments when determined necessary 
 17.18  by the commissioner and recommend changes to care plans that 
 17.19  will provide more efficient and appropriate home care. 
 17.20     (c) In addition, the commissioner or the commissioner's 
 17.21  designee may: 
 17.22     (1) review care plans and reimbursement data for 
 17.23  utilization of services that exceed community-based standards 
 17.24  for home care, inappropriate home care services, medical 
 17.25  necessity, home care services that do not meet quality of care 
 17.26  standards, or unauthorized services and make appropriate 
 17.27  referrals within the department or to other appropriate entities 
 17.28  based on the findings; 
 17.29     (2) assist the recipient in obtaining services necessary to 
 17.30  allow the recipient to remain safely in or return to the 
 17.31  community; 
 17.32     (3) coordinate home care services with other medical 
 17.33  assistance services under section 256B.0625; 
 17.34     (4) assist the recipient with problems related to the 
 17.35  provision of home care services; and 
 17.36     (5) assure the quality of home care services. 
 18.1      (d) For the purposes of this section, "home care services"  
 18.2   means medical assistance services defined under section 
 18.3   256B.0625, subdivisions 6a, 7, and 19a. 
 18.4      Sec. 7.  Minnesota Statutes 1994, section 256B.0911, 
 18.5   subdivision 2, is amended to read: 
 18.6      Subd. 2.  [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.] 
 18.7   All applicants to Medicaid certified nursing facilities must be 
 18.8   screened prior to admission, regardless of income, assets, or 
 18.9   funding sources, except the following: 
 18.10     (1) patients who, having entered acute care facilities from 
 18.11  certified nursing facilities, are returning to a certified 
 18.12  nursing facility; 
 18.13     (2) residents transferred from other certified nursing 
 18.14  facilities located within the state of Minnesota; 
 18.15     (3) individuals who have a contractual right to have their 
 18.16  nursing facility care paid for indefinitely by the veteran's 
 18.17  administration; or 
 18.18     (4) individuals who are enrolled in the Ebenezer/Group 
 18.19  Health social health maintenance organization project at the 
 18.20  time of application to a nursing home; or 
 18.21     (5) individuals previously screened and currently being 
 18.22  served under the alternative care or waiver programs. 
 18.23     Regardless of the exemptions in clauses (2) to (4), persons 
 18.24  who have a diagnosis or possible diagnosis of mental illness, 
 18.25  mental retardation, or a related condition must be screened 
 18.26  before admission unless the admission prior to screening is 
 18.27  authorized by the local mental health authority or the local 
 18.28  developmental disabilities case manager, or unless authorized by 
 18.29  the county agency according to Public Law Number 101-508. 
 18.30     Before admission to a Medicaid certified nursing home or 
 18.31  boarding care home, all persons must be screened and approved 
 18.32  for admission through an assessment process.  The nursing 
 18.33  facility is authorized to conduct case mix assessments which are 
 18.34  not conducted by the county public health nurse under Minnesota 
 18.35  Rules, part 9549.0059.  The designated county agency is 
 18.36  responsible for distributing the quality assurance and review 
 19.1   form for all new applicants to nursing homes. 
 19.2      Other persons who are not applicants to nursing facilities 
 19.3   must be screened if a request is made for a screening. 
 19.4      Sec. 8.  Minnesota Statutes 1994, section 256B.0913, 
 19.5   subdivision 4, is amended to read: 
 19.6      Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
 19.7   NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
 19.8   under the alternative care program is available to persons who 
 19.9   meet the following criteria: 
 19.10     (1) the person has been screened by the county screening 
 19.11  team or, if previously screened and served under the alternative 
 19.12  care program, assessed by the local county social worker or 
 19.13  public health nurse; 
 19.14     (2) the person is age 65 or older; 
 19.15     (3) the person would be financially eligible for medical 
 19.16  assistance within 180 days of admission to a nursing facility; 
 19.17     (4) the person meets the asset transfer requirements of the 
 19.18  medical assistance program; 
 19.19     (5) the screening team would recommend nursing facility 
 19.20  admission or continued stay for the person if alternative care 
 19.21  services were not available; 
 19.22     (6) the person needs services that are not available at 
 19.23  that time in the county through other county, state, or federal 
 19.24  funding sources; and 
 19.25     (7) the monthly annual cost of the alternative care 
 19.26  services funded by the program for this person does, divided by 
 19.27  12, shall not exceed 75 percent of the statewide average monthly 
 19.28  medical assistance payment for nursing facility care at the 
 19.29  individual's case mix classification to which the individual 
 19.30  would be assigned under Minnesota Rules, parts 9549.0050 to 
 19.31  9549.0059. 
 19.32     (b) Individuals who meet the criteria in paragraph (a) and 
 19.33  who have been approved for alternative care funding are called 
 19.34  180-day eligible clients. 
 19.35     (c) The statewide average payment for nursing facility care 
 19.36  is the statewide average monthly nursing facility rate in effect 
 20.1   on July 1 of the fiscal year in which the cost is incurred, less 
 20.2   the statewide average monthly income of nursing facility 
 20.3   residents who are age 65 or older and who are medical assistance 
 20.4   recipients in the month of March of the previous fiscal year.  
 20.5   This monthly limit does not prohibit the 180-day eligible client 
 20.6   from paying for additional services needed or desired.  
 20.7      (d) In determining the total costs of alternative care 
 20.8   services for one month, the costs of all services funded by the 
 20.9   alternative care program, including supplies and equipment, must 
 20.10  be included. 
 20.11     (e) Alternative care funding under this subdivision is not 
 20.12  available for a person who is a medical assistance recipient or 
 20.13  who would be eligible for medical assistance without a spenddown 
 20.14  if the person applied, unless authorized by the commissioner.  A 
 20.15  person whose application for medical assistance is being 
 20.16  processed may be served under the alternative care program for a 
 20.17  period up to 60 days.  If the individual is found to be eligible 
 20.18  for medical assistance, the county must bill medical assistance 
 20.19  from the date the individual was found eligible for the medical 
 20.20  assistance services provided that are reimbursable under the 
 20.21  elderly waiver program.  
 20.22     (f) Alternative care funding is not available for a person 
 20.23  who resides in a licensed nursing home or boarding care home, 
 20.24  except for case management services which are being provided in 
 20.25  support of the discharge planning process.  
 20.26     Sec. 9.  Minnesota Statutes 1994, section 256B.0913, 
 20.27  subdivision 5, is amended to read: 
 20.28     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
 20.29  Alternative care funding may be used for payment of costs of: 
 20.30     (1) adult foster care; 
 20.31     (2) adult day care; 
 20.32     (3) home health aide; 
 20.33     (4) homemaker services; 
 20.34     (5) personal care; 
 20.35     (6) case management; 
 20.36     (7) respite care; 
 21.1      (8) assisted living; 
 21.2      (9) residential care services; 
 21.3      (10) care-related supplies and equipment; 
 21.4      (11) meals delivered to the home; 
 21.5      (12) transportation; 
 21.6      (13) skilled nursing; 
 21.7      (14) chore services; 
 21.8      (15) companion services; 
 21.9      (16) nutrition services; and 
 21.10     (17) training for direct informal caregivers. 
 21.11     (b) The county agency must ensure that the funds are used 
 21.12  only to supplement and not supplant services available through 
 21.13  other public assistance or services programs. 
 21.14     (c) Unless specified in statute, the service standards for 
 21.15  alternative care services shall be the same as the service 
 21.16  standards defined in the elderly waiver.  Persons or agencies 
 21.17  must be employed by or under a contract with the county agency 
 21.18  or the public health nursing agency of the local board of health 
 21.19  in order to receive funding under the alternative care program. 
 21.20     (d) The adult foster care rate shall be considered a 
 21.21  difficulty of care payment and shall not include room and 
 21.22  board.  The adult foster care daily rate shall be negotiated 
 21.23  between the county agency and the foster care provider.  The 
 21.24  rate established under this section shall not exceed 75 percent 
 21.25  of the state average monthly nursing home payment for the case 
 21.26  mix classification to which the individual receiving foster care 
 21.27  is assigned, and it must allow for other alternative care 
 21.28  services to be authorized by the case manager. 
 21.29     (e) Personal care services may be provided by a personal 
 21.30  care provider organization.  A county agency may contract with a 
 21.31  relative of the client to provide personal care services, but 
 21.32  must ensure nursing supervision.  Covered personal care services 
 21.33  defined in section 256B.0627, subdivision 4, must meet 
 21.34  applicable standards in Minnesota Rules, part 9505.0335. 
 21.35     (f) Costs for supplies and equipment that exceed $150 per 
 21.36  item per month must have prior approval from the commissioner.  
 22.1   A county may use alternative care funds to purchase supplies and 
 22.2   equipment from a non-Medicaid certified vendor if the cost for 
 22.3   the items is less than that of a Medicaid vendor.  A county is 
 22.4   not required to contract with a provider of supplies and 
 22.5   equipment if the monthly cost of the supplies or equipment is 
 22.6   less than $250.  
 22.7      (g) For purposes of this section, residential care services 
 22.8   are services which are provided to individuals living in 
 22.9   residential care homes.  Residential care homes are currently 
 22.10  licensed as board and lodging establishments and are registered 
 22.11  with the department of health as providing special services.  
 22.12  Residential care services are defined as "supportive services" 
 22.13  and "health-related services."  "Supportive services" means the 
 22.14  provision of up to 24-hour supervision and oversight.  
 22.15  Supportive services includes:  (1) transportation, when provided 
 22.16  by the residential care center only; (2) socialization, when 
 22.17  socialization is part of the plan of care, has specific goals 
 22.18  and outcomes established, and is not diversional or recreational 
 22.19  in nature; (3) assisting clients in setting up meetings and 
 22.20  appointments; (4) assisting clients in setting up medical and 
 22.21  social services; (5) providing assistance with personal laundry, 
 22.22  such as carrying the client's laundry to the laundry room.  
 22.23  Assistance with personal laundry does not include any laundry, 
 22.24  such as bed linen, that is included in the room and board rate.  
 22.25  Health-related services are limited to minimal assistance with 
 22.26  dressing, grooming, and bathing and providing reminders to 
 22.27  residents to take medications that are self-administered or 
 22.28  providing storage for medications, if requested.  Individuals 
 22.29  receiving residential care services cannot receive both personal 
 22.30  care services and residential care services.  
 22.31     (h) For the purposes of this section, "assisted living" 
 22.32  refers to supportive services provided by a single vendor to 
 22.33  clients who reside in the same apartment building of three or 
 22.34  more units.  Assisted living services are defined as up to 
 22.35  24-hour supervision, and oversight, supportive services as 
 22.36  defined in clause (1), individualized home care aide tasks as 
 23.1   defined in clause (2), and individualized home management tasks 
 23.2   as defined in clause (3) provided to residents of a residential 
 23.3   center living in their units or apartments with a full kitchen 
 23.4   and bathroom.  A full kitchen includes a stove, oven, 
 23.5   refrigerator, food preparation counter space, and a kitchen 
 23.6   utensil storage compartment.  Assisted living services must be 
 23.7   provided by the management of the residential center or by 
 23.8   providers under contract with the management or with the county. 
 23.9      (1) Supportive services include:  
 23.10     (i) socialization, when socialization is part of the plan 
 23.11  of care, has specific goals and outcomes established, and is not 
 23.12  diversional or recreational in nature; 
 23.13     (ii) assisting clients in setting up meetings and 
 23.14  appointments; and 
 23.15     (iii) providing transportation, when provided by the 
 23.16  residential center only.  
 23.17     Individuals receiving assisted living services will not 
 23.18  receive both assisted living services and homemaking or personal 
 23.19  care services.  Individualized means services are chosen and 
 23.20  designed specifically for each resident's needs, rather than 
 23.21  provided or offered to all residents regardless of their 
 23.22  illnesses, disabilities, or physical conditions.  
 23.23     (2) Home care aide tasks means:  
 23.24     (i) preparing modified diets, such as diabetic or low 
 23.25  sodium diets; 
 23.26     (ii) reminding residents to take regularly scheduled 
 23.27  medications or to perform exercises; 
 23.28     (iii) household chores in the presence of technically 
 23.29  sophisticated medical equipment or episodes of acute illness or 
 23.30  infectious disease; 
 23.31     (iv) household chores when the resident's care requires the 
 23.32  prevention of exposure to infectious disease or containment of 
 23.33  infectious disease; and 
 23.34     (v) assisting with dressing, oral hygiene, hair care, 
 23.35  grooming, and bathing, if the resident is ambulatory, and if the 
 23.36  resident has no serious acute illness or infectious disease.  
 24.1   Oral hygiene means care of teeth, gums, and oral prosthetic 
 24.2   devices.  
 24.3      (3) Home management tasks means:  
 24.4      (i) housekeeping; 
 24.5      (ii) laundry; 
 24.6      (iii) preparation of regular snacks and meals; and 
 24.7      (iv) shopping.  
 24.8      A person's eligibility to reside in the building must not 
 24.9   be contingent on the person's acceptance or use of the assisted 
 24.10  living services.  Assisted living services as defined in this 
 24.11  section shall not be authorized in boarding and lodging 
 24.12  establishments licensed according to sections 157.01 to 157.031. 
 24.13     (i) For the purposes of this section, reimbursement for 
 24.14  assisted living services and residential care services shall 
 24.15  be made by the lead agency to the vendor as a monthly rate 
 24.16  negotiated with and authorized by the county agency.  The rate 
 24.17  shall not exceed the nonfederal share of the greater of either 
 24.18  the statewide or any of the geographic groups' weighted average 
 24.19  monthly medical assistance nursing facility payment rate of the 
 24.20  case mix resident class to which the 180-day eligible client 
 24.21  would be assigned under Minnesota Rules, parts 9549.0050 to 
 24.22  9549.0059, except.  For alternative care assisted living 
 24.23  projects established under Laws 1988, chapter 689, article 2, 
 24.24  section 256, whose monthly rates may not exceed 65 percent of 
 24.25  either the greater of either statewide or any of the geographic 
 24.26  groups' weighted average monthly medical assistance nursing 
 24.27  facility payment rate of the case mix resident class to which 
 24.28  the 180-day eligible client would be assigned under Minnesota 
 24.29  Rules, parts 9549.0050 to 9549.0059.  The rate may not cover 
 24.30  rent and direct food costs. 
 24.31     (i) (j) For purposes of this section, companion services 
 24.32  are defined as nonmedical care, supervision and oversight, 
 24.33  provided to a functionally impaired adult.  Companions may 
 24.34  assist the individual with such tasks as meal preparation, 
 24.35  laundry and shopping, but do not perform these activities as 
 24.36  discrete services.  The provision of companion services does not 
 25.1   entail hands-on medical care.  Providers may also perform light 
 25.2   housekeeping tasks which are incidental to the care and 
 25.3   supervision of the recipient.  This service must be approved by 
 25.4   the case manager as part of the care plan.  Companion services 
 25.5   must be provided by individuals or nonprofit organizations who 
 25.6   are under contract with the local agency to provide the 
 25.7   service.  Any person related to the waiver recipient by blood, 
 25.8   marriage or adoption cannot be reimbursed under this service.  
 25.9   Persons providing companion services will be monitored by the 
 25.10  case manager. 
 25.11     (j) (k) For purposes of this section, training for direct 
 25.12  informal caregivers is defined as a classroom or home course of 
 25.13  instruction which may include:  transfer and lifting skills, 
 25.14  nutrition, personal and physical cares, home safety in a home 
 25.15  environment, stress reduction and management, behavioral 
 25.16  management, long-term care decision making, care coordination 
 25.17  and family dynamics.  The training is provided to an informal 
 25.18  unpaid caregiver of a 180-day eligible client which enables the 
 25.19  caregiver to deliver care in a home setting with high levels of 
 25.20  quality.  The training must be approved by the case manager as 
 25.21  part of the individual care plan.  Individuals, agencies, and 
 25.22  educational facilities which provide caregiver training and 
 25.23  education will be monitored by the case manager. 
 25.24     Sec. 10.  Minnesota Statutes 1994, section 256B.0913, 
 25.25  subdivision 8, is amended to read: 
 25.26     Subd. 8.  [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 
 25.27  case manager shall implement the plan of care for each 180-day 
 25.28  eligible client and ensure that a client's service needs and 
 25.29  eligibility are reassessed at least every six 12 months.  The 
 25.30  plan shall include any services prescribed by the individual's 
 25.31  attending physician as necessary to allow the individual to 
 25.32  remain in a community setting.  In developing the individual's 
 25.33  care plan, the case manager should include the use of volunteers 
 25.34  from families and neighbors, religious organizations, social 
 25.35  clubs, and civic and service organizations to support the formal 
 25.36  home care services.  The county shall be held harmless for 
 26.1   damages or injuries sustained through the use of volunteers 
 26.2   under this subdivision including workers' compensation 
 26.3   liability.  The lead agency shall provide documentation to the 
 26.4   commissioner verifying that the individual's alternative care is 
 26.5   not available at that time through any other public assistance 
 26.6   or service program.  The lead agency shall provide documentation 
 26.7   in each individual's plan of care and to the commissioner that 
 26.8   the most cost-effective alternatives available have been offered 
 26.9   to the individual and that the individual was free to choose 
 26.10  among available qualified providers, both public and private. 
 26.11  The case manager must give the individual a ten-day written 
 26.12  notice of any decrease in or termination of alternative care 
 26.13  services. 
 26.14     (b) If the county of service is different from the county 
 26.15  of financial responsibility for an alternative care client, the 
 26.16  county of service must notify the county of financial 
 26.17  responsibility verbally or in writing that the client is 
 26.18  eligible to receive alternative care services.  If the county of 
 26.19  financial responsibility requests additional information 
 26.20  regarding the client's eligibility for services, the county of 
 26.21  service must provide the requested information.  
 26.22     Sec. 11.  Minnesota Statutes 1994, section 256B.0913, 
 26.23  subdivision 12, is amended to read: 
 26.24     Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
 26.25  all 180-day eligible clients to help pay for the cost of 
 26.26  participating in the program.  The amount of the premium for the 
 26.27  alternative care client shall be determined as follows: 
 26.28     (1) when the alternative care client's income less 
 26.29  recurring and predictable medical expenses is greater than the 
 26.30  medical assistance income standard but less than 150 percent of 
 26.31  the federal poverty guideline, and total assets are less than 
 26.32  $6,000, the fee is zero; 
 26.33     (2) when the alternative care client's income less 
 26.34  recurring and predictable medical expenses is greater than 150 
 26.35  percent of the federal poverty guideline, and total assets are 
 26.36  less than $6,000, the fee is 25 percent of the cost of 
 27.1   alternative care services or the difference between 150 percent 
 27.2   of the federal poverty guideline and the client's income less 
 27.3   recurring and predictable medical expenses, whichever is less; 
 27.4   and 
 27.5      (3) when the alternative care client's total assets are 
 27.6   greater than $6,000, the fee is 25 percent of the cost of 
 27.7   alternative care services.  
 27.8      For married persons, total assets are defined as the total 
 27.9   marital assets less the estimated community spouse asset 
 27.10  allowance, under section 256B.059, if applicable.  For married 
 27.11  persons, total income is defined as the client's income less the 
 27.12  monthly spousal allotment, under section 256B.058. 
 27.13     All alternative care services except case management shall 
 27.14  be included in the estimated costs for the purpose of 
 27.15  determining 25 percent of the costs. 
 27.16     The monthly premium shall be calculated and be payable in 
 27.17  the based on the cost of the first full month in which the of 
 27.18  alternative care services begin and shall continue unaltered for 
 27.19  six months until the semiannual reassessment unless the actual 
 27.20  cost of services falls below the fee until the next reassessment 
 27.21  is completed or at the end of 12 months, whichever comes first.  
 27.22  Premiums are due and payable each month alternative care 
 27.23  services are received unless the actual cost of the services is 
 27.24  less than the premium. 
 27.25     (b) The fee shall be waived by the commissioner when: 
 27.26     (1) a person who is residing in a nursing facility is 
 27.27  receiving case management only; 
 27.28     (2) a person is applying for medical assistance; 
 27.29     (3) a married couple is requesting an asset assessment 
 27.30  under the spousal impoverishment provisions; 
 27.31     (4) a person is a medical assistance recipient, but has 
 27.32  been approved for alternative care-funded assisted living 
 27.33  services; 
 27.34     (5) a person is found eligible for alternative care, but is 
 27.35  not yet receiving alternative care services; or 
 27.36     (6) a person is an adult foster care resident for whom 
 28.1   alternative care funds are being used to meet a portion of the 
 28.2   person's medical assistance spenddown, as authorized in 
 28.3   subdivision 4; and 
 28.4      (7) a person's fee under paragraph (a) is less than $25. 
 28.5      (c) The county agency must collect the premium from the 
 28.6   client and forward the amounts collected to the commissioner in 
 28.7   the manner and at the times prescribed by the commissioner.  
 28.8   Money collected must be deposited in the general fund and is 
 28.9   appropriated to the commissioner for the alternative care 
 28.10  program.  The client must supply the county with the client's 
 28.11  social security number at the time of application.  If a client 
 28.12  fails or refuses to pay the premium due, the county shall supply 
 28.13  the commissioner with the client's social security number and 
 28.14  other information the commissioner requires to collect the 
 28.15  premium from the client.  The commissioner shall collect unpaid 
 28.16  premiums using the revenue recapture act in chapter 270A and 
 28.17  other methods available to the commissioner.  The commissioner 
 28.18  may require counties to inform clients of the collection 
 28.19  procedures that may be used by the state if a premium is not 
 28.20  paid.  
 28.21     (d) The commissioner shall begin to adopt emergency or 
 28.22  permanent rules governing client premiums within 30 days after 
 28.23  July 1, 1991, including criteria for determining when services 
 28.24  to a client must be terminated due to failure to pay a premium.  
 28.25     Sec. 12.  Minnesota Statutes 1994, section 256B.0913, 
 28.26  subdivision 14, is amended to read: 
 28.27     Subd. 14.  [REIMBURSEMENT AND RATE ADJUSTMENTS.] (a) 
 28.28  Reimbursement for expenditures for the alternative care services 
 28.29  as approved by the client's case manager shall be through the 
 28.30  invoice processing procedures of the department's Medicaid 
 28.31  Management Information System (MMIS), only with the approval of 
 28.32  the client's case manager.  To receive reimbursement, the county 
 28.33  or vendor must submit invoices within 120 days 12 months 
 28.34  following the month date of service.  The county agency and its 
 28.35  vendors under contract shall not be reimbursed for services 
 28.36  which exceed the county allocation. 
 29.1      (b) If a county collects less than 50 percent of the client 
 29.2   premiums due under subdivision 12, the commissioner may withhold 
 29.3   up to three percent of the county's final alternative care 
 29.4   program allocation determined under subdivisions 10 and 11. 
 29.5      (c) Beginning July 1, 1991, the state will reimburse 
 29.6   counties, up to the limits of state appropriations, according to 
 29.7   the payment schedule in section 256.025 for the county share of 
 29.8   costs incurred under this subdivision on or after January 1, 
 29.9   1991, for individuals who would be eligible for medical 
 29.10  assistance within 180 days of admission to a nursing home. 
 29.11     (d) For fiscal years beginning on or after July 1, 1993, 
 29.12  the commissioner of human services shall not provide automatic 
 29.13  annual inflation adjustments for alternative care services.  The 
 29.14  commissioner of finance shall include as a budget change request 
 29.15  in each biennial detailed expenditure budget submitted to the 
 29.16  legislature under section 16A.11 annual adjustments in 
 29.17  reimbursement rates for alternative care services based on the 
 29.18  forecasted percentage change in the Home Health Agency Market 
 29.19  Basket of Operating Costs, for the fiscal year beginning July 1, 
 29.20  compared to the previous fiscal year, unless otherwise adjusted 
 29.21  by statute.  The Home Health Agency Market Basket of Operating 
 29.22  Costs is published by Data Resources, Inc.  The forecast to be 
 29.23  used is the one published for the calendar quarter beginning 
 29.24  January 1, six months prior to the beginning of the fiscal year 
 29.25  for which rates are set. 
 29.26     (e) The county shall negotiate individual rates with 
 29.27  vendors and may be reimbursed for actual costs up to the greater 
 29.28  of the county's current approved rate or 60 percent of the 
 29.29  maximum rate in fiscal year 1994 and 65 percent of the maximum 
 29.30  rate in fiscal year 1995 for each alternative care service.  
 29.31  Notwithstanding any other rule or statutory provision to the 
 29.32  contrary, the commissioner shall not be authorized to increase 
 29.33  rates by an annual inflation factor, unless so authorized by the 
 29.34  legislature. 
 29.35     (f) On July 1, 1993, the commissioner shall increase the 
 29.36  maximum rate for home delivered meals to $4.50 per meal. 
 30.1      Sec. 13.  Minnesota Statutes 1994, section 256B.0915, 
 30.2   subdivision 3, is amended to read: 
 30.3      Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 
 30.4   FORECASTING.] (a) The number of medical assistance waiver 
 30.5   recipients that a county may serve must be allocated according 
 30.6   to the number of medical assistance waiver cases open on July 1 
 30.7   of each fiscal year.  Additional recipients may be served with 
 30.8   the approval of the commissioner. 
 30.9      (b) The monthly limit for the cost of waivered services to 
 30.10  an individual waiver client shall be the statewide average 
 30.11  payment rate of the case mix resident class to which the waiver 
 30.12  client would be assigned under the medical assistance case mix 
 30.13  reimbursement system.  The statewide average payment rate is 
 30.14  calculated by determining the statewide average monthly nursing 
 30.15  home rate, effective July 1 of the fiscal year in which the cost 
 30.16  is incurred, less the statewide average monthly income of 
 30.17  nursing home residents who are age 65 or older, and who are 
 30.18  medical assistance recipients in the month of March of the 
 30.19  previous state fiscal year.  The annual cost divided by 12 of 
 30.20  elderly or disabled waivered services for a person who is a 
 30.21  nursing facility resident at the time of requesting a 
 30.22  determination of eligibility for elderly or disabled waivered 
 30.23  services shall not exceed the monthly payment for the resident 
 30.24  class assigned under Minnesota Rules, parts 9549.0050 to 
 30.25  9549.0059 for that resident in the nursing facility where the 
 30.26  resident currently resides.  The following costs must be 
 30.27  included in determining the total monthly costs for the waiver 
 30.28  client: 
 30.29     (1) cost of all waivered services, including extended 
 30.30  medical supplies and equipment; and 
 30.31     (2) cost of skilled nursing, home health aide, and personal 
 30.32  care services reimbursable by medical assistance.  
 30.33     (c) Medical assistance funding for skilled nursing 
 30.34  services, home health aide, and personal care services for 
 30.35  waiver recipients must be approved by the case manager and 
 30.36  included in the individual care plan. 
 31.1      (d) Expenditures for extended medical supplies and 
 31.2   equipment that cost over $150 per month for both the elderly 
 31.3   waiver and the disabled waiver must have the commissioner's 
 31.4   prior approval.  A county is not required to contract with a 
 31.5   provider of supplies and equipment if the monthly cost of the 
 31.6   supplies or equipment is less than $250.  
 31.7      (e) For the fiscal year beginning on July 1, 1993, and for 
 31.8   subsequent fiscal years, the commissioner of human services 
 31.9   shall not provide automatic annual inflation adjustments for 
 31.10  home and community-based waivered services.  The commissioner of 
 31.11  finance shall include as a budget change request in each 
 31.12  biennial detailed expenditure budget submitted to the 
 31.13  legislature under section 16A.11, annual adjustments in 
 31.14  reimbursement rates for home and community-based waivered 
 31.15  services, based on the forecasted percentage change in the Home 
 31.16  Health Agency Market Basket of Operating Costs, for the fiscal 
 31.17  year beginning July 1, compared to the previous fiscal year, 
 31.18  unless otherwise adjusted by statute.  The Home Health Agency 
 31.19  Market Basket of Operating Costs is published by Data Resources, 
 31.20  Inc.  The forecast to be used is the one published for the 
 31.21  calendar quarter beginning January 1, six months prior to the 
 31.22  beginning of the fiscal year for which rates are set.  The adult 
 31.23  foster care rate shall be considered a difficulty of care 
 31.24  payment and shall not include room and board. 
 31.25     (f) The adult foster care daily rate for the elderly and 
 31.26  disabled waivers shall be negotiated between the county agency 
 31.27  and the foster care provider.  The rate established under this 
 31.28  section shall not exceed the state average monthly nursing home 
 31.29  payment for the case mix classification to which the individual 
 31.30  receiving foster care is assigned, and it; the rate must allow 
 31.31  for other waiver and medical assistance home care services to be 
 31.32  authorized by the case manager. 
 31.33     (g) The assisted living and residential care service rates 
 31.34  for elderly and disabled community alternatives for disabled 
 31.35  individuals (CADI) waivers shall be made to the vendor as a 
 31.36  monthly rate negotiated with the county agency.  The rate shall 
 32.1   not exceed the nonfederal share of the greater of either the 
 32.2   statewide or any of the geographic groups' weighted average 
 32.3   monthly medical assistance nursing facility payment rate of the 
 32.4   case mix resident class to which the elderly or disabled client 
 32.5   would be assigned under Minnesota Rules, parts 9549.0050 to 
 32.6   9549.0059, except.  For alternative care assisted living 
 32.7   projects established under Laws 1988, chapter 689, article 2, 
 32.8   section 256, whose monthly rates may not exceed 65 percent of 
 32.9   the greater of either the statewide or any of the geographic 
 32.10  groups' weighted average monthly medical assistance nursing 
 32.11  facility payment rate for the case mix resident class to which 
 32.12  the elderly or disabled client would be assigned under Minnesota 
 32.13  Rules, parts 9549.0050 to 9549.0059.  The rate may not cover 
 32.14  direct rent or food costs. 
 32.15     (h) The county shall negotiate individual rates with 
 32.16  vendors and may be reimbursed for actual costs up to the greater 
 32.17  of the county's current approved rate or 60 percent of the 
 32.18  maximum rate in fiscal year 1994 and 65 percent of the maximum 
 32.19  rate in fiscal year 1995 for each service within each program. 
 32.20     (i) On July 1, 1993, the commissioner shall increase the 
 32.21  maximum rate for home-delivered meals to $4.50 per meal. 
 32.22     (j) Reimbursement for the medical assistance recipients 
 32.23  under the approved waiver shall be made from the medical 
 32.24  assistance account through the invoice processing procedures of 
 32.25  the department's Medicaid Management Information System (MMIS), 
 32.26  only with the approval of the client's case manager.  The budget 
 32.27  for the state share of the Medicaid expenditures shall be 
 32.28  forecasted with the medical assistance budget, and shall be 
 32.29  consistent with the approved waiver.  
 32.30     (k) Beginning July 1, 1991, the state shall reimburse 
 32.31  counties according to the payment schedule in section 256.025 
 32.32  for the county share of costs incurred under this subdivision on 
 32.33  or after January 1, 1991, for individuals who are receiving 
 32.34  medical assistance. 
 32.35     Sec. 14.  Minnesota Statutes 1994, section 256B.0915, 
 32.36  subdivision 5, is amended to read: 
 33.1      Subd. 5.  [REASSESSMENTS FOR WAIVER CLIENTS.] A 
 33.2   reassessment of a client served under the elderly or disabled 
 33.3   waiver must be conducted at least every six 12 months and at 
 33.4   other times when the case manager determines that there has been 
 33.5   significant change in the client's functioning.  This may 
 33.6   include instances where the client is discharged from the 
 33.7   hospital.  
 33.8      Sec. 15.  Minnesota Statutes 1994, section 256B.0915, is 
 33.9   amended by adding a subdivision to read: 
 33.10     Subd. 6.  [NOTIFICATION.] If the county of service is 
 33.11  different from the county of financial responsibility for an 
 33.12  elderly or disabled waiver client, the county of service must 
 33.13  notify the county of financial responsibility verbally or in 
 33.14  writing that the client is eligible to receive elderly or 
 33.15  disabled waiver services.  If the county of financial 
 33.16  responsibility requests additional information regarding the 
 33.17  client's eligibility for services, the county of service must 
 33.18  provide the requested information. 
 33.19     Sec. 16.  Minnesota Statutes 1994, section 256B.093, 
 33.20  subdivision 1, is amended to read: 
 33.21     Subdivision 1.  [STATE TRAUMATIC BRAIN INJURY PROGRAM.] The 
 33.22  commissioner of human services shall: 
 33.23     (1) establish and maintain a statewide traumatic brain 
 33.24  injury program; 
 33.25     (2) designate a full-time position to supervise and 
 33.26  coordinate services and policies for persons with traumatic 
 33.27  brain injuries; 
 33.28     (3) contract with qualified agencies or employ staff to 
 33.29  provide statewide administrative case management and 
 33.30  consultation; 
 33.31     (4) establish maintain an advisory committee to provide 
 33.32  recommendations in a report reports to the commissioner 
 33.33  regarding program and service needs of persons with traumatic 
 33.34  brain injuries.  The advisory committee shall consist of no less 
 33.35  than ten members and no more than 30 members.  The commissioner 
 33.36  shall appoint all advisory committee members to one- or two-year 
 34.1   terms and appoint one member as chair; and 
 34.2      (5) investigate the need for the development of rules or 
 34.3   statutes for:  
 34.4      (i) develop rules for traumatic brain injury home and 
 34.5   community-based services waiver; and 
 34.6      (ii) traumatic brain injury services not covered by any 
 34.7   other statute or rule (6) investigate present and potential 
 34.8   models of service coordination which can be delivered at the 
 34.9   local level.  
 34.10     Sec. 17.  Minnesota Statutes 1994, section 256B.093, 
 34.11  subdivision 2, is amended to read: 
 34.12     Subd. 2.  [ELIGIBILITY.] Persons eligible for traumatic 
 34.13  brain injury administrative case management and consultation 
 34.14  must be eligible medical assistance recipients who have 
 34.15  traumatic or certain acquired brain injury and: 
 34.16     (1) are at risk of institutionalization; or 
 34.17     (2) exceed limits established by the commissioner in 
 34.18  section 256B.0627, subdivision 5, paragraph (b). 
 34.19     Sec. 18.  Minnesota Statutes 1994, section 256B.093, 
 34.20  subdivision 3, is amended to read: 
 34.21     Subd. 3.  [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 
 34.22  department shall fund administrative case management under this 
 34.23  subdivision using medical assistance administrative funds.  The 
 34.24  traumatic brain injury program duties include: 
 34.25     (1) assessing the person's individual needs for services 
 34.26  required to prevent institutionalization; 
 34.27     (2) ensuring that a care plan that addresses the person's 
 34.28  needs is developed, implemented, and monitored on an ongoing 
 34.29  basis by the appropriate agency or individual; 
 34.30     (3) assisting the person in obtaining services necessary to 
 34.31  allow the person to remain in the community; 
 34.32     (4) coordinating home care services with other medical 
 34.33  assistance services under section 256B.0625; 
 34.34     (5) ensuring appropriate, accessible, and cost-effective 
 34.35  medical assistance services; 
 34.36     (6) recommending to the commissioner the approval or denial 
 35.1   of the use of medical assistance funds to pay for home care 
 35.2   services when home care services exceed thresholds established 
 35.3   by the commissioner under section 256B.0627; 
 35.4      (7) assisting the person with problems related to the 
 35.5   provision of home care services; 
 35.6      (8) ensuring the quality of home care services; 
 35.7      (9) reassessing the person's need for and level of home 
 35.8   care services at a frequency determined by the commissioner; 
 35.9      (10) (1) recommending to the commissioner the approval or 
 35.10  denial of medical assistance funds to pay for out-of-state 
 35.11  placements for traumatic brain injury services and in-state 
 35.12  traumatic brain injury services provided by designated Medicare 
 35.13  long-term care hospitals; 
 35.14     (11) (2) coordinating the traumatic brain injury home and 
 35.15  community-based waiver; and 
 35.16     (12) (3) approving traumatic brain injury waiver 
 35.17  eligibility or care plans or both; 
 35.18     (4) providing ongoing technical assistance and consultation 
 35.19  to county and facility case managers to facilitate care plan 
 35.20  development for appropriate, accessible, and cost-effective 
 35.21  medical assistance services; 
 35.22     (5) providing technical assistance to promote statewide 
 35.23  development of appropriate, accessible, and cost-effective 
 35.24  medical assistance services and related policy; 
 35.25     (6) providing training and outreach to facilitate access to 
 35.26  appropriate home and community-based services to prevent 
 35.27  institutionalization; 
 35.28     (7) facilitating appropriate admissions, continued stay 
 35.29  review, discharges, and utilization review for neurobehavioral 
 35.30  hospitals and other specialized institutions; 
 35.31     (8) providing technical assistance on the use of prior 
 35.32  authorization of home care services and coordination of these 
 35.33  services with other medical assistance services; and 
 35.34     (9) developing a system for identification of nursing 
 35.35  facility and hospital residents with traumatic brain injury to 
 35.36  assist in long-term planning for medical assistance services.  
 36.1   Factors will include, but are not limited to, number of 
 36.2   individuals served, length of stay, services received, and 
 36.3   barriers to community placement. 
 36.4      Sec. 19.  Minnesota Statutes 1994, section 256I.03, 
 36.5   subdivision 5, is amended to read: 
 36.6      Subd. 5.  [MSA EQUIVALENT RATE.] "MSA equivalent rate" 
 36.7   means an amount equal to the total of:  
 36.8      (1) the combined maximum shelter and basic needs standards 
 36.9   for MSA recipients living alone specified in section 256D.44, 
 36.10  subdivisions 2, paragraph (a); and 3, paragraph (a); plus 
 36.11     (2) for persons who are not eligible to receive food stamps 
 36.12  due to living arrangement, the maximum allotment authorized by 
 36.13  the federal Food Stamp Program for a single individual which is 
 36.14  in effect on the first day of July each year; less 
 36.15     (3) the personal needs allowance authorized for medical 
 36.16  assistance recipients under section 256B.35.  
 36.17     The MSA equivalent rate is to be adjusted on the first day 
 36.18  of July each year to reflect changes in any of the component 
 36.19  rates under clauses (1) to (3). 
 36.20     Sec. 20.  Minnesota Statutes 1994, section 256I.03, is 
 36.21  amended by adding a subdivision to read: 
 36.22     Subd. 7.  [COUNTABLE INCOME.] "Countable income" means all 
 36.23  income received by an applicant or recipient less any applicable 
 36.24  exclusions or disregards.  For a recipient of any cash benefit 
 36.25  from the SSI program, countable income means the SSI benefit 
 36.26  limit in effect at the time the person is in a GRH setting less 
 36.27  $20, less the medical assistance personal needs allowance.  If 
 36.28  the SSI limit has been reduced for a person due to events 
 36.29  occurring prior to the persons entering the GRH setting, 
 36.30  countable income means actual income less any applicable 
 36.31  exclusions and disregards. 
 36.32     Sec. 21.  Minnesota Statutes 1994, section 256I.04, is 
 36.33  amended to read: 
 36.34     256I.04 [ELIGIBILITY FOR GROUP RESIDENTIAL HOUSING 
 36.35  PAYMENT.] 
 36.36     Subdivision 1.  [INDIVIDUAL ELIGIBILITY REQUIREMENTS.] An 
 37.1   individual is eligible for and entitled to a group residential 
 37.2   housing payment to be made on the individual's behalf if the 
 37.3   county agency has approved the individual's residence in a group 
 37.4   residential housing setting and the individual meets the 
 37.5   requirements in paragraph (a) or (b).  
 37.6      (a) The individual is aged, blind, or is over 18 years of 
 37.7   age and disabled as determined under the criteria used by the 
 37.8   title II program of the Social Security Act, and meets the 
 37.9   resource restrictions and standards of the supplemental security 
 37.10  income program, and the individual's countable income after 
 37.11  deducting the exclusions and disregards of the SSI program and 
 37.12  the medical assistance personal needs allowance under section 
 37.13  256B.35 is less than the monthly rate specified in the county 
 37.14  agency's agreement with the provider of group residential 
 37.15  housing in which the individual resides.  
 37.16     (b) The individual's resources are less than the standards 
 37.17  specified by section 256D.08, and the individual's countable 
 37.18  income as determined under sections 256D.01 to 256D.21, less the 
 37.19  medical assistance personal needs allowance under section 
 37.20  256B.35 is less than the monthly rate specified in the county 
 37.21  agency's agreement with the provider of group residential 
 37.22  housing in which the individual resides. 
 37.23     Subd. 1a.  [COUNTY APPROVAL.] A county agency may not 
 37.24  approve a group residential housing payment for an individual in 
 37.25  any setting with a rate in excess of the MSA equivalent rate for 
 37.26  more than 30 days in a calendar year unless the county agency 
 37.27  has developed or approved a plan for the individual which 
 37.28  specifies that:  
 37.29     (1) the individual has an illness or incapacity which 
 37.30  prevents the person from living independently in the community; 
 37.31  and 
 37.32     (2) the individual's illness or incapacity requires the 
 37.33  services which are available in the group residence. 
 37.34     The plan must be signed or countersigned by any of the 
 37.35  following employees of the county of financial responsibility:  
 37.36  the director of human services or a designee of the director; a 
 38.1   social worker; or a case aide. 
 38.2      Subd. 1b.  [OPTIONAL STATE SUPPLEMENTS TO SSI.] Group 
 38.3   residential housing payments made on behalf of persons eligible 
 38.4   under subdivision 1, paragraph (a), are optional state 
 38.5   supplements to the SSI program.  
 38.6      Subd. 1c.  [INTERIM ASSISTANCE.] Group residential housing 
 38.7   payments made on behalf of persons eligible under subdivision 1, 
 38.8   paragraph (b), are considered interim assistance payments to 
 38.9   applicants for the federal SSI program.  
 38.10     Subd. 2.  [DATE OF ELIGIBILITY.] An individual who has met 
 38.11  the eligibility requirements of subdivision 1, shall have a 
 38.12  group residential housing payment made on the individual's 
 38.13  behalf from the first day of the month in which a signed 
 38.14  application form is received by a county agency, or the first 
 38.15  day of the month in which all eligibility factors have been met, 
 38.16  whichever is later. 
 38.17     Subd. 2a.  [LICENSE REQUIRED.] A county agency may not 
 38.18  enter into an agreement with an establishment to provide group 
 38.19  residential housing unless:  
 38.20     (1) the establishment is licensed by the department of 
 38.21  health as a hotel and restaurant; a board and lodging 
 38.22  establishment; a residential care home; a boarding care home 
 38.23  before March 1, 1985; or a supervised living facility, and the 
 38.24  service provider for residents of the facility is licensed under 
 38.25  chapter 245A.  However, an establishment licensed by the 
 38.26  department of health to provide lodging need not also be 
 38.27  licensed to provide board if meals are being supplied to 
 38.28  residents under a contract with a food vendor who is licensed by 
 38.29  the department of health; or 
 38.30     (2) the residence is licensed by the commissioner of human 
 38.31  services under Minnesota Rules, parts 9555.5050 to 9555.6265, or 
 38.32  certified by a county human services agency prior to July 1, 
 38.33  1992, using the standards under Minnesota Rules, parts 9555.5050 
 38.34  to 9555.6265. 
 38.35     The requirements under clauses (1) and (2) do not apply to 
 38.36  establishments exempt from state licensure because they are 
 39.1   located on Indian reservations and subject to tribal health and 
 39.2   safety requirements. 
 39.3      Subd. 2b.  [GROUP RESIDENTIAL HOUSING AGREEMENTS.] 
 39.4   Agreements between county agencies and providers of group 
 39.5   residential housing must be in writing and must specify the name 
 39.6   and address under which the establishment subject to the 
 39.7   agreement does business and under which the establishment, or 
 39.8   service provider, if different from the group residential 
 39.9   housing establishment, is licensed by the department of health 
 39.10  or the department of human services; the specific license or 
 39.11  registration from the department of health or the department of 
 39.12  human services held by the provider and the number of beds 
 39.13  subject to that license; the address of the location or 
 39.14  locations at which group residential housing is provided under 
 39.15  this agreement; the per diem and monthly rates that are to be 
 39.16  paid from group residential housing funds for each eligible 
 39.17  resident at each location; the number of beds at each location 
 39.18  which are subject to the group residential housing agreement; 
 39.19  whether the license holder is a not-for-profit corporation under 
 39.20  section 501(c)(3) of the Internal Revenue Code; and a statement 
 39.21  that the agreement is subject to the provisions of sections 
 39.22  256I.01 to 256I.06 and subject to any changes to those sections. 
 39.23     Subd. 2c.  [CRISIS SHELTERS.] Secure crisis shelters for 
 39.24  battered women and their children designated by the Minnesota 
 39.25  department of corrections are not group residences under this 
 39.26  chapter. 
 39.27     Subd. 3.  [MORATORIUM ON THE DEVELOPMENT OF GROUP 
 39.28  RESIDENTIAL HOUSING BEDS.] (a) County agencies shall not enter 
 39.29  into agreements for new group residential housing beds with 
 39.30  total rates in excess of the MSA equivalent rate except:  (1) 
 39.31  for group residential housing establishments meeting the 
 39.32  requirements of subdivision 2a, clause (2) with department 
 39.33  approval; (2) for group residential housing establishments 
 39.34  licensed under Minnesota Rules, parts 9525.0215 to 9525.0355, 
 39.35  provided the facility is needed to meet the census reduction 
 39.36  targets for persons with mental retardation or related 
 40.1   conditions at regional treatment centers; (3) to ensure 
 40.2   compliance with the federal Omnibus Budget Reconciliation Act 
 40.3   alternative disposition plan requirements for inappropriately 
 40.4   placed persons with mental retardation or related conditions or 
 40.5   mental illness; or (4) up to 80 beds in a single, specialized 
 40.6   facility located in Hennepin county that will provide housing 
 40.7   for chronic inebriates who are repetitive users of 
 40.8   detoxification centers and are refused placement in emergency 
 40.9   shelters because of their state of intoxication.  Planning for 
 40.10  the specialized facility must have been initiated before July 1, 
 40.11  1991, in anticipation of receiving a grant from the housing 
 40.12  finance agency under section 462A.05, subdivision 20a, paragraph 
 40.13  (b). 
 40.14     (b) A county agency may enter into a group residential 
 40.15  housing agreement for beds with rates in excess of the MSA 
 40.16  equivalent rate in addition to those currently covered under a 
 40.17  group residential housing agreement if the additional beds are 
 40.18  only a replacement of beds with rates in excess of the MSA 
 40.19  equivalent rate which have been made available due to closure of 
 40.20  a setting, a change of licensure or certification which removes 
 40.21  the beds from group residential housing payment, or as a result 
 40.22  of the downsizing of a group residential housing setting.  The 
 40.23  transfer of available beds from one county to another can only 
 40.24  occur by the agreement of both counties. 
 40.25     (c) Group residential housing beds which become available 
 40.26  as a result of downsizing settings which have a license issued 
 40.27  under Minnesota Rules, parts 9520.0500 to 9520.0690, must be 
 40.28  permanently removed from the group residential housing census 
 40.29  and not replaced. 
 40.30     Sec. 22.  Minnesota Statutes 1994, section 256I.05, 
 40.31  subdivision 1, is amended to read: 
 40.32     Subdivision 1.  [MAXIMUM RATES.] (a) Monthly room and board 
 40.33  rates negotiated by a county agency for a recipient living in 
 40.34  group residential housing must not exceed the MSA equivalent 
 40.35  rate specified under section 256I.03, subdivision 5, with the 
 40.36  exception that a county agency may negotiate a room and board 
 41.1   rate that exceeds the MSA equivalent rate by up to $426.37 for 
 41.2   recipients of waiver services under title XIX of the Social 
 41.3   Security Act.  This exception is subject to the following 
 41.4   conditions: 
 41.5      (1) that the Secretary of Health and Human Services has not 
 41.6   approved a state request to include room and board costs which 
 41.7   exceed the MSA equivalent rate in an individual's set of waiver 
 41.8   services under title XIX of the Social Security Act; or 
 41.9      (2) that the Secretary of Health and Human Services has 
 41.10  approved the inclusion of room and board costs which exceed the 
 41.11  MSA equivalent rate, but in an amount that is insufficient to 
 41.12  cover costs which are included in a group residential housing 
 41.13  agreement in effect on June 30, 1994,; and 
 41.14     (3) the amount of the rate that is above the MSA equivalent 
 41.15  rate has been approved by the commissioner.  The county agency 
 41.16  may at any time negotiate a lower room and board rate than the 
 41.17  rate that would otherwise be paid under this subdivision. 
 41.18     (b) The maximum monthly rate for an establishment that 
 41.19  enters into an initial group residential housing agreement with 
 41.20  a county agency on or after June 1, 1989, may not exceed 90 
 41.21  percent of the maximum rate established under this subdivision.  
 41.22  This is effective until June 30, 1994. 
 41.23     Sec. 23.  Minnesota Statutes 1994, section 256I.05, 
 41.24  subdivision 1a, is amended to read: 
 41.25     Subd. 1a.  [SUPPLEMENTARY RATES.] In addition to the room 
 41.26  and board rate specified in subdivision 1, the county agency may 
 41.27  negotiate a payment not to exceed $426.37 for other services 
 41.28  necessary to provide room and board provided by the group 
 41.29  residence if the residence is licensed by or registered by the 
 41.30  department of health, or licensed by the department of human 
 41.31  services to provide services in addition to room and board, and 
 41.32  if the recipient provider of services is not also concurrently 
 41.33  receiving funding for services for a recipient under a home and 
 41.34  community-based waiver under title XIX of the Social Security 
 41.35  Act or residing in a setting which receives funding under 
 41.36  Minnesota Rules, parts 9535.2000 to 9535.3000.  If funding is 
 42.1   available for other necessary services through a home and 
 42.2   community-based waiver, then the GRH rate is limited to the rate 
 42.3   set in subdivision 1.  The registration and licensure 
 42.4   requirement does not apply to establishments which are exempt 
 42.5   from state licensure because they are located on Indian 
 42.6   reservations and for which the tribe has prescribed health and 
 42.7   safety requirements.  Service payments under this section may be 
 42.8   prohibited under rules to prevent the supplanting of federal 
 42.9   funds with state funds.  The commissioner shall pursue the 
 42.10  feasibility of obtaining the approval of the Secretary of Health 
 42.11  and Human Services to provide home and community-based waiver 
 42.12  services under title XIX of the Social Security Act for 
 42.13  residents who are not eligible for an existing home and 
 42.14  community-based waiver due to a primary diagnosis of mental 
 42.15  illness or chemical dependency and shall apply for a waiver if 
 42.16  it is determined to be cost-effective. 
 42.17     Sec. 24.  Minnesota Statutes 1994, section 256I.05, 
 42.18  subdivision 5, is amended to read: 
 42.19     Subd. 5.  [ADULT FOSTER CARE RATES.] The commissioner shall 
 42.20  annually establish statewide maintenance and difficulty of 
 42.21  care rates limits for adults in foster care.  The commissioner 
 42.22  shall adopt rules to implement statewide rates.  In adopting 
 42.23  rules, the commissioner shall consider existing maintenance and 
 42.24  difficulty of care rates so that, to the extent possible, an 
 42.25  adult for whom a maintenance or difficulty of care rate is 
 42.26  established will not be adversely affected.  
 42.27     Sec. 25.  Minnesota Statutes 1994, section 256I.06, 
 42.28  subdivision 2, is amended to read: 
 42.29     Subd. 2.  [TIME OF PAYMENT.] A county agency may make 
 42.30  payments to a group residence in advance for an individual whose 
 42.31  stay in the group residence is expected to last beyond the 
 42.32  calendar month for which the payment is made and who does not 
 42.33  expect to receive countable earned income during the month for 
 42.34  which the payment is made.  Group residential housing payments 
 42.35  made by a county agency on behalf of an individual who is not 
 42.36  expected to remain in the group residence beyond the month for 
 43.1   which payment is made must be made subsequent to the 
 43.2   individual's departure from the group residence.  Group 
 43.3   residential housing payments made by a county agency on behalf 
 43.4   of an individual with countable earned income must be made 
 43.5   subsequent to receipt of a monthly household report form. 
 43.6      Sec. 26.  Minnesota Statutes 1994, section 256I.06, 
 43.7   subdivision 6, is amended to read: 
 43.8      Subd. 6.  [REPORTS.] Recipients must report changes in 
 43.9   circumstances that affect eligibility or group residential 
 43.10  housing payment amounts within ten days of the change.  
 43.11  Recipients with countable earned income must complete a monthly 
 43.12  household report form.  If the report form is not received 
 43.13  before the end of the month in which it is due, the county 
 43.14  agency must terminate eligibility for group residential housing 
 43.15  payments.  The termination shall be effective on the first day 
 43.16  of the month following the month in which the report was due.  
 43.17  If a complete report is received within the month eligibility 
 43.18  was terminated, the individual is considered to have continued 
 43.19  an application for group residential housing payment effective 
 43.20  the first day of the month the eligibility was terminated. 
 43.21     Sec. 27.  Laws 1993, First Special Session chapter 1, 
 43.22  article 8, section 30, subdivision 2, is amended to read: 
 43.23     Subd. 2.  Sections 1 to 3, 8, 9, 13 to 17, 22, 23, and 26 
 43.24  to 29 are effective July 1, 1994, contingent upon federal 
 43.25  recognition that group residential housing payments qualify as 
 43.26  optional state supplement payments to the supplemental security 
 43.27  income program under title XVI of the Social Security Act and 
 43.28  confer categorical eligibility for medical assistance under the 
 43.29  state plan for medical assistance.  The amendments and repeals 
 43.30  by Laws 1993, First Special Session chapter 1, article 8, 
 43.31  sections 1 to 3, 8, 9, 13 to 17, 22, 23, 26, and 29 are 
 43.32  effective July 1, 1994. 
 43.33     Sec. 28.  [EFFECTIVE DATES.] 
 43.34     Subdivision 1.  Sections 1 to 4 are effective January 1, 
 43.35  1996.  Section 5 is effective January 1, 1996, except the 
 43.36  following provisions in section 5 are effective July 1, 1995:  
 44.1   256B.0627, subdivision 5(d)(2)(i)(A) and (B); and (ii), and 
 44.2   subdivision 5(d)(3)(C). 
 44.3      Subd. 2.  Sections 6 to 27 are effective the day following 
 44.4   final enactment.