1.1                          A bill for an act
  1.2             relating to human services; modifying the requirements 
  1.3             for screening of certain medical assistance 
  1.4             recipients; amending Minnesota Statutes 1995 
  1.5             Supplement, section 256B.055, subdivision 12. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 1995 Supplement, section 
  1.8   256B.055, subdivision 12, is amended to read: 
  1.9      Subd. 12.  [DISABLED CHILDREN.] (a) A person is eligible 
  1.10  for medical assistance if the person is under age 19 and 
  1.11  qualifies as a disabled individual under United States Code, 
  1.12  title 42, section 1382c(a), and would be eligible for medical 
  1.13  assistance under the state plan if residing in a medical 
  1.14  institution, and the child requires a level of care provided in 
  1.15  a hospital, nursing facility, or intermediate care facility for 
  1.16  persons with mental retardation or related conditions, for whom 
  1.17  home care is appropriate, provided that the cost to medical 
  1.18  assistance under this section is not more than the amount that 
  1.19  medical assistance would pay for if the child resides in an 
  1.20  institution.  Eligibility under this section must be determined 
  1.21  annually.  After the child is determined to be eligible under 
  1.22  this section, the commissioner shall review the child's 
  1.23  disability under United States Code, title 42, section 1382c(a) 
  1.24  and level of care defined under this section no more often than 
  1.25  annually and may elect, based on the recommendation of health 
  2.1   care professionals under contract with the state medical review 
  2.2   team, to extend the review of disability and level of care up to 
  2.3   a maximum of four years.  The commissioner's decision on the 
  2.4   frequency of continuing review of disability and level of care 
  2.5   is not subject to administrative appeal under section 256.045.  
  2.6   Nothing in this subdivision shall be construed as affecting 
  2.7   other redeterminations of medical assistance eligibility under 
  2.8   this chapter and annual cost effective reviews under this 
  2.9   section. 
  2.10     (b) For purposes of this subdivision, "hospital" means an 
  2.11  institution as defined in section 144.696, subdivision 3, 
  2.12  144.55, subdivision 3, or Minnesota Rules, part 4640.3600, and 
  2.13  licensed pursuant to sections 144.50 to 144.58 .  For purposes 
  2.14  of this subdivision, a child requires a level of care provided 
  2.15  in a hospital if the child is determined by the commissioner to 
  2.16  need an extensive array of health services, including mental 
  2.17  health services, for an undetermined period of time, whose 
  2.18  health condition requires frequent monitoring and treatment by a 
  2.19  health care professional or by a person supervised by a health 
  2.20  care professional, who would reside in a hospital or require 
  2.21  frequent hospitalization if these services were not provided, 
  2.22  and the daily care needs are more complex than a nursing 
  2.23  facility level of care.  
  2.24     A child with serious emotional disturbance requires a level 
  2.25  of care provided in a hospital if the commissioner determines 
  2.26  that the individual requires 24-hour supervision because the 
  2.27  person exhibits recurrent or frequent suicidal or homicidal 
  2.28  ideation or behavior, recurrent or frequent psychosomatic 
  2.29  disorders or somatopsychic disorders that may become life 
  2.30  threatening, recurrent or frequent severe socially unacceptable 
  2.31  behavior associated with psychiatric disorder, ongoing and 
  2.32  chronic psychosis or severe, ongoing and chronic developmental 
  2.33  problems requiring continuous skilled observation, or severe 
  2.34  disabling symptoms for which office-centered outpatient 
  2.35  treatment is not adequate, and which overall severely impact the 
  2.36  individual's ability to function. 
  3.1      (c) For purposes of this subdivision, "nursing facility" 
  3.2   means a facility which provides nursing care as defined in 
  3.3   section 144A.01, subdivision 5, licensed pursuant to sections 
  3.4   144A.02 to 144A.10, which is appropriate if a person is in 
  3.5   active restorative treatment; is in need of special treatments 
  3.6   provided or supervised by a licensed nurse; or has unpredictable 
  3.7   episodes of active disease processes requiring immediate 
  3.8   judgment by a licensed nurse.  For purposes of this subdivision, 
  3.9   a child requires the level of care provided in a nursing 
  3.10  facility if the child is determined by the commissioner to meet 
  3.11  the requirements of the preadmission screening assessment 
  3.12  document under section 256B.0911 and the home care independent 
  3.13  rating document under section 256B.0627, subdivision 5, 
  3.14  paragraph (f), item (iii), adjusted to address age-appropriate 
  3.15  standards for children age 18 and under, pursuant to section 
  3.16  256B.0627, subdivision 5, paragraph (d), clause (2). 
  3.17     (d) For purposes of this subdivision, "intermediate care 
  3.18  facility for persons with mental retardation or related 
  3.19  conditions" or "ICF/MR" means a program licensed to provide 
  3.20  services to persons with mental retardation under section 
  3.21  252.28, and chapter 245A, and a physical plant licensed as a 
  3.22  supervised living facility under chapter 144, which together are 
  3.23  certified by the Minnesota department of health as meeting the 
  3.24  standards in Code of Federal Regulations, title 42, part 483, 
  3.25  for an intermediate care facility which provides services for 
  3.26  persons with mental retardation or persons with related 
  3.27  conditions who require 24-hour supervision and active treatment 
  3.28  for medical, behavioral, or habilitation needs.  For purposes of 
  3.29  this subdivision, a child requires a level of care provided in 
  3.30  an ICF/MR if the commissioner finds that the child has mental 
  3.31  retardation or a related condition in accordance with section 
  3.32  256B.092, is in need of a 24-hour plan of care and active 
  3.33  treatment similar to persons with mental retardation, and there 
  3.34  is a reasonable indication that the child will need ICF/MR 
  3.35  services. 
  3.36     (e) The determination of the level of care needed by the 
  4.1   child shall be made by the commissioner based on information 
  4.2   supplied to the commissioner by the parent or guardian, the 
  4.3   child's physician or physicians , and other professionals as 
  4.4   requested by the commissioner.  The commissioner shall establish 
  4.5   a screening team to conduct the level of care determinations 
  4.6   according to this subdivision. 
  4.7      (f) If a child meets the conditions in paragraph (b), (c), 
  4.8   or (d), the commissioner must assess the case to determine 
  4.9   whether: 
  4.10     (1) the child qualifies as a disabled individual under 
  4.11  United States Code, title 42, section 1382c(a) and would be 
  4.12  eligible for medical assistance if residing in a medical 
  4.13  institution; and 
  4.14     (2) the cost of medical assistance services for the child, 
  4.15  if eligible under this subdivision, would not be more than the 
  4.16  cost to medical assistance if the child resides in a medical 
  4.17  institution to be determined as follows: 
  4.18     (i) for a child who requires a level of care provided in an 
  4.19  ICF/MR, the cost of care for the child in an institution shall 
  4.20  be determined using the average payment rate established for the 
  4.21  regional treatment centers that are certified as ICFs/MR; 
  4.22     (ii) for a child who requires a level of care provided in 
  4.23  an inpatient hospital setting according to paragraph (b), 
  4.24  cost-effectiveness shall be determined according to Minnesota 
  4.25  Rules, part 9505.3520, items F and G; and 
  4.26     (iii) for a child who requires a level of care provided in 
  4.27  a nursing facility according to paragraph (c), 
  4.28  cost-effectiveness shall be determined according to Minnesota 
  4.29  Rules, part 9505.3040, except that the nursing facility average 
  4.30  rate shall be adjusted to reflect rates which would be paid for 
  4.31  children under age 16.  The commissioner may authorize an amount 
  4.32  up to the amount medical assistance would pay for a child 
  4.33  referred to the commissioner by the preadmission screening team 
  4.34  under section 256B.0911. 
  4.35     (g) Children eligible for medical assistance services under 
  4.36  section 256B.055, subdivision 12, as of June 30, 1995, must be 
  5.1   screened according to the criteria in this subdivision prior to 
  5.2   January 1, 1996.  Children found to be ineligible may not be 
  5.3   removed from the program until January 1, 1996.