1.1                          A bill for an act
  1.2             relating to home care; modifying an exemption from the 
  1.3             definition of provider; requiring rules to include 
  1.4             certain standards; establishing an assisted living 
  1.5             home care provider license; redefining elderly housing 
  1.6             with services establishment; modifying reimbursement 
  1.7             procedures for assisted living services under medical 
  1.8             assistance and alternative care; defining certain 
  1.9             housing with services establishments as a permitted 
  1.10            single family residential use of property for zoning 
  1.11            purposes; requiring a study; amending Minnesota 
  1.12            Statutes 1996, sections 144A.43, subdivision 4; 
  1.13            144A.45, subdivision 1, and by adding a subdivision; 
  1.14            144A.46, subdivisions 1 and 3; 144D.01, subdivisions 
  1.15            4, 5, 6, and by adding a subdivision; 144D.03, 
  1.16            subdivision 1; 144D.06; 157.17, subdivisions 2 and 5; 
  1.17            245A.03, subdivision 2; 256B.0913, subdivision 5; 
  1.18            256B.0915, subdivision 3; 256I.04, subdivision 2a; and 
  1.19            462.357, subdivision 7; proposing coding for new law 
  1.20            in Minnesota Statutes, chapters 144A; and 144D; 
  1.21            repealing Minnesota Statutes 1996, sections 144A.45, 
  1.22            subdivision 3; 144A.49; 144B.01; 144B.02; 144B.03; 
  1.23            144B.04; 144B.05; 144B.06; 144B.07; 144B.08; 144B.09; 
  1.24            144B.10; 144B.11; 144B.12; 144B.13; 144B.14; 144B.15; 
  1.25            144B.16; and 144B.17. 
  1.26  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.27     Section 1.  Minnesota Statutes 1996, section 144A.43, 
  1.28  subdivision 4, is amended to read: 
  1.29     Subd. 4.  [HOME CARE PROVIDER.] "Home care provider" means 
  1.30  an individual, organization, association, corporation, unit of 
  1.31  government, or other entity that is regularly engaged in the 
  1.32  delivery, directly or by contractual arrangement, of home care 
  1.33  services for a fee.  At least one home care service must be 
  1.34  provided directly, although additional home care services may be 
  1.35  provided by contractual arrangements.  "Home care provider" 
  2.1   includes a hospice program defined in section 144A.48.  "Home 
  2.2   care provider" does not include: 
  2.3      (1) any home care or nursing services conducted by and for 
  2.4   the adherents of any recognized church or religious denomination 
  2.5   for the purpose of providing care and services for those who 
  2.6   depend upon spiritual means, through prayer alone, for healing; 
  2.7      (2) an individual who only provides services to a relative; 
  2.8      (3) an individual not connected with a home care provider 
  2.9   who provides assistance with home management services or 
  2.10  personal care needs if the assistance is provided primarily as a 
  2.11  contribution and not as a business; 
  2.12     (4) an individual not connected with a home care provider 
  2.13  who shares housing with and provides primarily housekeeping or 
  2.14  homemaking services to an elderly or disabled person in return 
  2.15  for free or reduced-cost housing; 
  2.16     (5) an individual or agency providing home-delivered meal 
  2.17  services; 
  2.18     (6) an agency providing senior companion services and other 
  2.19  older American volunteer programs established under the Domestic 
  2.20  Volunteer Service Act of 1973, Public Law Number 98-288; 
  2.21     (7) an employee of a nursing home licensed under this 
  2.22  chapter or an employee of a boarding care home licensed under 
  2.23  sections 144.50 to 144.56 who provides responds to occasional 
  2.24  emergency services to calls from individuals residing in an 
  2.25  apartment unit attached to a residential setting that is 
  2.26  attached to or located on property contiguous to the nursing 
  2.27  home or boarding care home; 
  2.28     (8) a member of a professional corporation organized under 
  2.29  sections 319A.01 to 319A.22 that does not regularly offer or 
  2.30  provide home care services as defined in subdivision 3; 
  2.31     (9) the following organizations established to provide 
  2.32  medical or surgical services that do not regularly offer or 
  2.33  provide home care services as defined in subdivision 3:  a 
  2.34  business trust organized under sections 318.01 to 318.04, a 
  2.35  nonprofit corporation organized under chapter 317A, a 
  2.36  partnership organized under chapter 323, or any other entity 
  3.1   determined by the commissioner; 
  3.2      (10) an individual or agency that provides medical supplies 
  3.3   or durable medical equipment, except when the provision of 
  3.4   supplies or equipment is accompanied by a home care service; 
  3.5      (11) an individual licensed under chapter 147; or 
  3.6      (12) an individual who provides home care services to a 
  3.7   person with a developmental disability who lives in a place of 
  3.8   residence with a family, foster family, or primary caregiver. 
  3.9      Sec. 2.  Minnesota Statutes 1996, section 144A.45, 
  3.10  subdivision 1, is amended to read: 
  3.11     Subdivision 1.  [RULES.] The commissioner shall adopt rules 
  3.12  for the regulation of home care providers pursuant to sections 
  3.13  144A.43 to 144A.49.  The rules shall include the following:  
  3.14     (a) provisions to assure, to the extent possible, the 
  3.15  health, safety and well-being, and appropriate treatment of 
  3.16  persons who receive home care services; 
  3.17     (b) requirements that home care providers furnish the 
  3.18  commissioner with specified information necessary to implement 
  3.19  sections 144A.43 to 144A.49; 
  3.20     (c) standards of training of home care provider personnel, 
  3.21  which may vary according to the nature of the services provided 
  3.22  or the health status of the consumer; 
  3.23     (d) standards for medication management which may vary 
  3.24  according to the nature of the services provided, the setting in 
  3.25  which the services are provided or the status of the consumer.  
  3.26  Medication management includes the central storage, handling, 
  3.27  distribution, and administration of medications; 
  3.28     (e) standards of for supervision of home care services 
  3.29  requiring supervision by a registered nurse or other appropriate 
  3.30  health care professionals of personnel providing home care 
  3.31  services, which may vary according to the nature of the services 
  3.32  provided or the health status of the consumer professional which 
  3.33  must occur on site at least every 62 days, or more frequently if 
  3.34  indicated by a clinical assessment, and in accordance with 
  3.35  sections 148.171 to 148.285 and rules adopted thereunder; 
  3.36     (f) standards for client evaluation or assessment which may 
  4.1   vary according to the nature of the services provided or the 
  4.2   status of the consumer; 
  4.3      (e) (g) requirements for the involvement of a consumer's 
  4.4   physician, the documentation of physicians' orders, if required, 
  4.5   and the consumer's treatment plan, and the maintenance of 
  4.6   accurate, current clinical records; 
  4.7      (f) (h) the establishment of different classes of licenses 
  4.8   for different types of providers and different standards and 
  4.9   requirements for different kinds of home care services; and 
  4.10     (g) (i) operating procedures required to implement the home 
  4.11  care bill of rights. 
  4.12     Sec. 3.  Minnesota Statutes 1996, section 144A.45, is 
  4.13  amended by adding a subdivision to read: 
  4.14     Subd. 4.  [MEDICAID REIMBURSEMENT.] Notwithstanding the 
  4.15  provisions of section 256B.071 or state plan requirements to the 
  4.16  contrary, certification by the federal Medicare program must not 
  4.17  be a requirement of Medicaid payment for services delivered 
  4.18  under section 144A.4605. 
  4.19     Sec. 4.  Minnesota Statutes 1996, section 144A.46, 
  4.20  subdivision 1, is amended to read: 
  4.21     Subdivision 1.  [LICENSE REQUIRED.] (a) A home care 
  4.22  provider may not operate in the state without a current license 
  4.23  issued by the commissioner of health.  A home care provider may 
  4.24  hold a separate license for each class of home care licensure. 
  4.25     (b) Within ten days after receiving an application for a 
  4.26  license, the commissioner shall acknowledge receipt of the 
  4.27  application in writing.  The acknowledgment must indicate 
  4.28  whether the application appears to be complete or whether 
  4.29  additional information is required before the application will 
  4.30  be considered complete.  Within 90 days after receiving a 
  4.31  complete application, the commissioner shall either grant or 
  4.32  deny the license.  If an applicant is not granted or denied a 
  4.33  license within 90 days after submitting a complete application, 
  4.34  the license must be deemed granted.  An applicant whose license 
  4.35  has been deemed granted must provide written notice to the 
  4.36  commissioner before providing a home care service. 
  5.1      (c) Each application for a home care provider license, or 
  5.2   for a renewal of a license, shall be accompanied by a fee to be 
  5.3   set by the commissioner under section 144.122. 
  5.4      Sec. 5.  Minnesota Statutes 1996, section 144A.46, 
  5.5   subdivision 3, is amended to read: 
  5.6      Subd. 3.  [ENFORCEMENT.] (a) The commissioner may refuse to 
  5.7   grant or renew a license, or may suspend or revoke a license, 
  5.8   for violation of statutes or rules relating to home care 
  5.9   services or for conduct detrimental to the welfare of the 
  5.10  consumer.  Prior to any suspension, revocation, or refusal to 
  5.11  renew a license, the home care provider shall be entitled to 
  5.12  notice and a hearing as provided by sections 14.57 to 14.69.  In 
  5.13  addition to any other remedy provided by law, the commissioner 
  5.14  may, without a prior contested case hearing, temporarily suspend 
  5.15  a license or prohibit delivery of services by a provider for not 
  5.16  more than 60 days if the commissioner determines that the health 
  5.17  or safety of a consumer is in imminent danger, provided (1) 
  5.18  advance notice is given to the provider; (2) after notice, the 
  5.19  provider fails to correct the problem; (3) the commissioner has 
  5.20  reason to believe that other administrative remedies are not 
  5.21  likely to be effective; and (4) there is an opportunity for a 
  5.22  contested case hearing within the 60 days.  The process of 
  5.23  suspending or revoking a license must include a plan for 
  5.24  transferring affected clients to other providers.  
  5.25     (b) The owner and managerial officials, as defined in the 
  5.26  home care licensure rules, Minnesota Rules, chapter 4668, of a 
  5.27  home care provider whose Minnesota license has not been renewed 
  5.28  or has been revoked because of noncompliance with applicable law 
  5.29  or rule shall not be eligible to apply for nor will be granted a 
  5.30  license for five years following the effective date of the 
  5.31  nonrenewal or revocation.  Such individuals shall also not be an 
  5.32  owner or managerial official of any other home care provider for 
  5.33  five years following the effective date of the nonrenewal or 
  5.34  revocation. 
  5.35     (c) The commissioner shall not issue a license to a home 
  5.36  care provider if an owner or managerial official includes any 
  6.1   individual who was an owner or managerial official of a home 
  6.2   care provider whose Minnesota license was not renewed or was 
  6.3   revoked as described in paragraph (b) for five years following 
  6.4   the effective date of nonrenewal or revocation.  Notwithstanding 
  6.5   the provisions of paragraph (a), the commissioner shall not 
  6.6   renew, or shall suspend or revoke the license of any home care 
  6.7   provider which, after the date of initial licensure, includes 
  6.8   any individual as an owner or managerial official who was an 
  6.9   owner or managerial official of a home care provider whose 
  6.10  Minnesota license was not renewed or was revoked as described in 
  6.11  paragraph (b) for five years following the effective date of the 
  6.12  nonrenewal or revocation.  The commissioner shall notify the 
  6.13  home care provider 30 days in advance of the date of nonrenewal, 
  6.14  suspension, or revocation of the license. 
  6.15     (d) The provisions contained in paragraphs (b) and (c) 
  6.16  shall apply to any nonrenewal or revocation of a home care 
  6.17  license occurring after June 1, 1993, the effective date of the 
  6.18  home care licensure rules. 
  6.19     (e) The provisions contained in paragraphs (b) and (c) 
  6.20  apply only to owners of a home care provider who had sufficient 
  6.21  authority to affect or change decisions related to the operation 
  6.22  of the home care agency and to managerial officials whose duties 
  6.23  included the direction of the management or policies relating to 
  6.24  the areas of noncompliance which led to the license revocation 
  6.25  or nonrenewal. 
  6.26     Sec. 6.  [144A.4605] [ASSISTED LIVING HOME CARE PROVIDER.] 
  6.27     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  6.28  section, the term "assisted living home care provider" means a 
  6.29  home care provider who provides nursing services, delegated 
  6.30  nursing services, other services performed by unlicensed 
  6.31  personnel, or central storage of medications solely for 
  6.32  residents of one or more housing with services establishments 
  6.33  registered under chapter 144D. 
  6.34     Subd. 2.  [ASSISTED LIVING HOME CARE LICENSE 
  6.35  ESTABLISHED.] A home care provider license category entitled 
  6.36  assisted living home care provider is hereby established.  A 
  7.1   home care provider may obtain an assisted living license if the 
  7.2   program meets the following requirements: 
  7.3      (a) nursing services, delegated nursing services, other 
  7.4   services performed by unlicensed personnel, or central storage 
  7.5   of medications under the assisted living license are provided 
  7.6   solely for residents of one or more housing with services 
  7.7   establishments registered under chapter 144D; 
  7.8      (b) unlicensed personnel perform home health aide and home 
  7.9   care aide tasks identified in Minnesota Rules, parts 4668.0100, 
  7.10  subparts 1 and 2, and 4668.0110, subpart 1.  Qualifications to 
  7.11  perform these tasks shall be established in accordance with 
  7.12  subdivision 3; 
  7.13     (c) periodic supervision of unlicensed personnel is 
  7.14  provided as required by rule; 
  7.15     (d) notwithstanding Minnesota Rules, part 4668.0160, 
  7.16  subpart 6, item D, client records shall include: 
  7.17     (1) a weekly summary of the client's status and home care 
  7.18  services provided; 
  7.19     (2) documentation each time medications are administered to 
  7.20  a client; and 
  7.21     (3) documentation on the day of occurrence of any 
  7.22  significant change in the client's status or any significant 
  7.23  incident, such as a fall or refusal to take medications. 
  7.24     All entries must be signed by the staff providing the 
  7.25  services and entered into the record no later than two weeks 
  7.26  after the end of the service day, except as specified in clauses 
  7.27  (2) and (3); 
  7.28     (e) medication and treatment orders, if any, are included 
  7.29  in the client record and are renewed at least every 12 months, 
  7.30  or more frequently when indicated by a clinical assessment; 
  7.31     (f) the central storage of medications in a housing with 
  7.32  services establishment registered under chapter 144D is managed 
  7.33  under a system that is established by a registered nurse and 
  7.34  addresses the control of medications, handling of medications, 
  7.35  medication containers, medication records, and disposition of 
  7.36  medications; and 
  8.1      (g) in other respects meets the requirements established by 
  8.2   rules adopted under sections 144A.45 to 144A.48. 
  8.3      Subd. 3.  [TRAINING OR COMPETENCY EVALUATIONS REQUIRED.] (a)
  8.4   Unlicensed personnel must: 
  8.5      (1) satisfy the training or competency requirements 
  8.6   established by rule under sections 144A.45 to 144A.48; or 
  8.7      (2) be trained or determined competent by a registered 
  8.8   nurse in each task identified under Minnesota Rules, part 
  8.9   4668.0100, subparts 1 and 2, when offered to clients in a 
  8.10  housing with services establishment as described in paragraphs 
  8.11  (b) to (e). 
  8.12     (b) Training for tasks identified under Minnesota Rules, 
  8.13  part 4668.0100, subparts 1 and 2, shall use a curriculum which 
  8.14  meets the requirements in Minnesota Rules, part 4668.0130. 
  8.15     (c) Competency evaluations for tasks identified under 
  8.16  Minnesota Rules, part 4668.0100, subparts 1 and 2, must be 
  8.17  completed and documented by a registered nurse. 
  8.18     (d) Unlicensed personnel performing tasks identified under 
  8.19  Minnesota Rules, part 4668.0100, subparts 1 and 2, shall be 
  8.20  trained or demonstrate competency in the following topics: 
  8.21     (1) an overview of sections 144A.43 to 144A.49 and rules 
  8.22  adopted thereunder; 
  8.23     (2) recognition and handling of emergencies and use of 
  8.24  emergency services; 
  8.25     (3) reporting the maltreatment of vulnerable minors or 
  8.26  adults under sections 626.556 and 626.557; 
  8.27     (4) home care bill of rights; 
  8.28     (5) handling of clients' complaints and reporting of 
  8.29  complaints to the office of health facility complaints; 
  8.30     (6) services of the ombudsman for older Minnesotans; 
  8.31     (7) observation, reporting, and documentation of client 
  8.32  status and of the care or services provided; 
  8.33     (8) basic infection control; 
  8.34     (9) maintenance of a clean, safe, and healthy environment; 
  8.35     (10) communication skills; 
  8.36     (11) basic elements of body functioning and changes in body 
  9.1   function that must be reported to an appropriate health care 
  9.2   professional; and 
  9.3      (12) physical, emotional, and developmental needs of 
  9.4   clients, and ways to work with clients who have problems in 
  9.5   these areas, including respect for the client, the client's 
  9.6   property, and the client's family. 
  9.7      (e) Unlicensed personnel who administer medications must 
  9.8   comply with rules relating to the administration of medications 
  9.9   in Minnesota Rules, part 4668.0100, subpart 2, except that 
  9.10  unlicensed personnel need not comply with the requirements of 
  9.11  Minnesota Rules, part 4668.0100, subpart 5. 
  9.12     Subd. 4.  [LICENSE REQUIRED.] (a) A housing with services 
  9.13  establishment registered under chapter 144D that is required to 
  9.14  obtain a home care license must obtain an assisted living home 
  9.15  care license according to this section or a class A license 
  9.16  according to rule. 
  9.17     (b) A board and lodging establishment registered for 
  9.18  special services as of December 31, 1996, and also registered as 
  9.19  a housing with services establishment under chapter 144D, must 
  9.20  deliver home care services according to sections 144A.43 to 
  9.21  144A.49, and may apply for a waiver from requirements under 
  9.22  Minnesota Rules, parts 4668.0002 to 4668.0240, to operate a 
  9.23  licensed agency under the standards of section 157.17.  Such 
  9.24  waivers as may be granted by the department will expire upon 
  9.25  promulgation of home care rules implementing section 144A.4605. 
  9.26     (c) An adult foster care provider licensed by the 
  9.27  department of human services and registered under chapter 144D 
  9.28  may continue to provide health-related services under its foster 
  9.29  care license until the promulgation of home care rules 
  9.30  implementing this section. 
  9.31     Subd. 5.  [LICENSE FEES.] The license fees for assisted 
  9.32  living home care providers shall be as follows: 
  9.33     (1) $125 annually for those providers serving a monthly 
  9.34  average of 15 or fewer clients, and for assisted living 
  9.35  providers of all sizes during the first year of operation; 
  9.36     (2) $200 annually for those providers serving a monthly 
 10.1   average of 16 to 30 clients; 
 10.2      (3) $375 annually for those providers serving a monthly 
 10.3   average of 31 to 50 clients; and 
 10.4      (4) $625 annually for those providers serving a monthly 
 10.5   average of 50 or more clients. 
 10.6      Subd. 6.  [WAIVER.] Upon request of the home care provider, 
 10.7   the commissioner may waive the provisions of this section 
 10.8   relating to registered nurse duties. 
 10.9      Sec. 7.  Minnesota Statutes 1996, section 144D.01, 
 10.10  subdivision 4, is amended to read: 
 10.11     Subd. 4.  [ELDERLY HOUSING WITH SERVICES ESTABLISHMENT OR 
 10.12  ESTABLISHMENT.] "Elderly Housing with services establishment" or 
 10.13  "establishment" means an establishment providing sleeping 
 10.14  accommodations to one or more adult residents, at least 80 
 10.15  percent of which are 55 years of age or older, and offering or 
 10.16  providing, for a fee, one or more regularly scheduled 
 10.17  health-related services or two or more regularly scheduled 
 10.18  supportive service services, whether offered or provided 
 10.19  directly by the establishment or by another entity arranged for 
 10.20  by the establishment. 
 10.21     Elderly Housing with services establishment does not 
 10.22  include: 
 10.23     (1) a nursing home licensed under chapter 144A; 
 10.24     (2) a hospital, boarding care home, or supervised living 
 10.25  facility licensed under sections 144.50 to 144.56; 
 10.26     (3) a board and lodging establishment licensed under 
 10.27  chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670, 
 10.28  9525.0215 to 9525.0355, 9525.0500 to 9525.0660, or 9530.4100 to 
 10.29  9530.4450; 
 10.30     (4) a board and lodging establishment which serves as a 
 10.31  shelter for battered women or other similar purpose; 
 10.32     (5) a family adult foster care home licensed under 
 10.33  Minnesota Rules, parts 9543.0010 to 9543.0150 by the department 
 10.34  of human services; or 
 10.35     (6) private homes in which the residents are related by 
 10.36  kinship, law, or affinity with the providers of services; 
 11.1      (7) a home-sharing arrangement such as when an elderly or 
 11.2   disabled person or single-parent family makes lodging in a 
 11.3   private residence available to another person in exchange for 
 11.4   services or rent, or both; 
 11.5      (8) a duly organized condominium, cooperative, common 
 11.6   interest community, or owners' association of the foregoing 
 11.7   where at least 80 percent of the units that comprise the 
 11.8   condominium, cooperative, or common interest community are 
 11.9   occupied by individuals who are the owners, members, or 
 11.10  shareholders of the units; or 
 11.11     (9) services for persons with developmental disabilities 
 11.12  that are provided under a license according to Minnesota Rules, 
 11.13  parts 9525.2000 to 9525.2140. 
 11.14     Sec. 8.  Minnesota Statutes 1996, section 144D.01, 
 11.15  subdivision 5, is amended to read: 
 11.16     Subd. 5.  [SUPPORTIVE SERVICES.] "Supportive services" 
 11.17  means arranging for medical services, health-related services, 
 11.18  social services, transportation, help with personal laundry, or 
 11.19  handling or assisting with personal funds of residents, or 
 11.20  arranging for medical services, health-related services, social 
 11.21  services, or transportation to medical or social services 
 11.22  appointments.  Arranging for services does not include making 
 11.23  referrals, assisting a resident in contacting a service provider 
 11.24  of the resident's choice, or contacting a service provider in an 
 11.25  emergency. 
 11.26     Sec. 9.  Minnesota Statutes 1996, section 144D.01, 
 11.27  subdivision 6, is amended to read: 
 11.28     Subd. 6.  [HEALTH-RELATED SERVICES.] "Health-related 
 11.29  services" include professional nursing services, home health 
 11.30  aide tasks, and home care aide tasks identified in Minnesota 
 11.31  Rules, parts 4668.0100, subparts 1 and 2; and 4668.0110, subpart 
 11.32  1,; or the central storage of medication for residents under 
 11.33  section 144A.485, subdivision 2, clause (6). 
 11.34     Sec. 10.  Minnesota Statutes 1996, section 144D.01, is 
 11.35  amended by adding a subdivision to read: 
 11.36     Subd. 7.  [FAMILY ADULT FOSTER CARE HOME.] "Family adult 
 12.1   foster care home" means an adult foster care home that is 
 12.2   licensed by the department of human services, that is the 
 12.3   primary residence of the license holder, and in which the 
 12.4   license holder is the primary caregiver. 
 12.5      Sec. 11.  Minnesota Statutes 1996, section 144D.03, 
 12.6   subdivision 1, is amended to read: 
 12.7      Subdivision 1.  [REGISTRATION PROCEDURES.] The commissioner 
 12.8   shall establish forms and procedures for annual registration 
 12.9   of elderly housing with services establishments.  The 
 12.10  commissioner shall charge an annual registration fee of $35.  No 
 12.11  fee shall be refunded.  A registered establishment shall notify 
 12.12  the commissioner within 30 days of the date it is no longer 
 12.13  required to be registered under this chapter or of any change in 
 12.14  the business name or address of the establishment, the name or 
 12.15  mailing address of the owner or owners, or the name or mailing 
 12.16  address of the managing agent.  There shall be no fee for 
 12.17  submission of the notice. 
 12.18     Sec. 12.  [144D.035] [RESTRAINTS.] 
 12.19     Residents must be free from any physical or chemical 
 12.20  restraints imposed for purposes of discipline or convenience. 
 12.21     Sec. 13.  Minnesota Statutes 1996, section 144D.06, is 
 12.22  amended to read: 
 12.23     144D.06 [OTHER LAWS.] 
 12.24     An elderly A housing with services establishment shall 
 12.25  obtain and maintain all other licenses, permits, registrations, 
 12.26  or other governmental approvals required of it in addition to 
 12.27  registration under this chapter, except that an establishment 
 12.28  registered under this chapter is exempt, at its option, from the 
 12.29  requirement of obtaining and maintaining an adult foster care 
 12.30  license under Minnesota Rules, parts 9543.0010 to 9543.0150, or 
 12.31  a lodging license under chapter 157.  An elderly.  A housing 
 12.32  with services establishment is subject to the provisions of 
 12.33  sections 504.01 to 504.28 and 566.01 to 566.175.  An elderly 
 12.34  housing with services establishment which is also described in 
 12.35  section 157.17 is exempt from the requirements of that section 
 12.36  while it is registered under this chapter. 
 13.1      Sec. 14.  Minnesota Statutes 1996, section 157.17, 
 13.2   subdivision 2, is amended to read: 
 13.3      Subd. 2.  [REGISTRATION.] At the time of licensure or 
 13.4   license renewal, a boarding and lodging establishment or a 
 13.5   lodging establishment that provides supportive services or 
 13.6   health supervision services must be registered with the 
 13.7   commissioner, and must register annually thereafter.  The 
 13.8   registration must include the name, address, and telephone 
 13.9   number of the establishment, the name of the operator, the types 
 13.10  of services that are being provided, a description of the 
 13.11  residents being served, the type and qualifications of staff in 
 13.12  the facility, and other information that is necessary to 
 13.13  identify the needs of the residents and the types of services 
 13.14  that are being provided.  The commissioner shall develop and 
 13.15  furnish to the boarding and lodging establishment or lodging 
 13.16  establishment the necessary form for submitting the 
 13.17  registration.  The requirement for registration is effective 
 13.18  until the rules required by sections 144B.01 to 144B.17 are 
 13.19  effective. 
 13.20     Housing with services establishments registered under 
 13.21  chapter 144D shall be considered registered under this section 
 13.22  for all purposes except that: 
 13.23     (1) the establishments shall operate under the requirements 
 13.24  of chapter 144D; and 
 13.25     (2) the criminal background check requirements of sections 
 13.26  299C.66 to 299C.71 apply.  The criminal background check 
 13.27  requirements of section 144.057 apply only to personnel 
 13.28  providing home care services under sections 144A.43 to 144A.48. 
 13.29     Sec. 15.  Minnesota Statutes 1996, section 157.17, 
 13.30  subdivision 5, is amended to read: 
 13.31     Subd. 5.  [SERVICES THAT MAY NOT BE PROVIDED IN A BOARDING 
 13.32  AND LODGING ESTABLISHMENT OR LODGING ESTABLISHMENT.] Except 
 13.33  those facilities registered under chapter 144D, a boarding and 
 13.34  lodging establishment or lodging establishment may not admit or 
 13.35  retain individuals who: 
 13.36     (1) would require assistance from establishment staff 
 14.1   because of the following needs:  bowel incontinence, catheter 
 14.2   care, use of injectable or parenteral medications, wound care, 
 14.3   or dressing changes or irrigations of any kind; or 
 14.4      (2) require a level of care and supervision beyond 
 14.5   supportive services or health supervision services. 
 14.6      Sec. 16.  Minnesota Statutes 1996, section 245A.03, 
 14.7   subdivision 2, is amended to read: 
 14.8      Subd. 2.  [EXCLUSION FROM LICENSURE.] Sections 245A.01 to 
 14.9   245A.16 do not apply to: 
 14.10     (1) residential or nonresidential programs that are 
 14.11  provided to a person by an individual who is related unless the 
 14.12  residential program is a foster care placement made by a local 
 14.13  social services agency or a licensed child-placing agency, 
 14.14  except as provided in subdivision 2a; 
 14.15     (2) nonresidential programs that are provided by an 
 14.16  unrelated individual to persons from a single related family; 
 14.17     (3) residential or nonresidential programs that are 
 14.18  provided to adults who do not abuse chemicals or who do not have 
 14.19  a chemical dependency, a mental illness, mental retardation or a 
 14.20  related condition, a functional impairment, or a physical 
 14.21  handicap; 
 14.22     (4) sheltered workshops or work activity programs that are 
 14.23  certified by the commissioner of economic security; 
 14.24     (5) programs for children enrolled in kindergarten to the 
 14.25  12th grade and prekindergarten special education in a school as 
 14.26  defined in section 120.101, subdivision 4, and programs serving 
 14.27  children in combined special education and regular 
 14.28  prekindergarten programs that are operated or assisted by the 
 14.29  commissioner of children, families, and learning; 
 14.30     (6) nonresidential programs primarily for children that 
 14.31  provide care or supervision, without charge for ten or fewer 
 14.32  days a year, and for periods of less than three hours a day 
 14.33  while the child's parent or legal guardian is in the same 
 14.34  building as the nonresidential program or present within another 
 14.35  building that is directly contiguous to the building in which 
 14.36  the nonresidential program is located; 
 15.1      (7) nursing homes or hospitals licensed by the commissioner 
 15.2   of health except as specified under section 245A.02; 
 15.3      (8) board and lodge facilities licensed by the commissioner 
 15.4   of health that provide services for five or more persons whose 
 15.5   primary diagnosis is mental illness who have refused an 
 15.6   appropriate residential program offered by a county agency.  
 15.7   This exclusion expires on July 1, 1990; 
 15.8      (9) homes providing programs for persons placed there by a 
 15.9   licensed agency for legal adoption, unless the adoption is not 
 15.10  completed within two years; 
 15.11     (10) programs licensed by the commissioner of corrections; 
 15.12     (11) recreation programs for children or adults that 
 15.13  operate for fewer than 40 calendar days in a calendar year; 
 15.14     (12) programs operated by a school as defined in section 
 15.15  120.101, subdivision 4, whose primary purpose is to provide 
 15.16  child care to school-age children, provided the program is 
 15.17  approved by the district's school board; 
 15.18     (13) head start nonresidential programs which operate for 
 15.19  less than 31 days in each calendar year; 
 15.20     (14) noncertified boarding care homes unless they provide 
 15.21  services for five or more persons whose primary diagnosis is 
 15.22  mental illness or mental retardation; 
 15.23     (15) nonresidential programs for nonhandicapped children 
 15.24  provided for a cumulative total of less than 30 days in any 
 15.25  12-month period; 
 15.26     (16) residential programs for persons with mental illness, 
 15.27  that are located in hospitals, until the commissioner adopts 
 15.28  appropriate rules; 
 15.29     (17) the religious instruction of school-age children; 
 15.30  Sabbath or Sunday schools; or the congregate care of children by 
 15.31  a church, congregation, or religious society during the period 
 15.32  used by the church, congregation, or religious society for its 
 15.33  regular worship; 
 15.34     (18) camps licensed by the commissioner of health under 
 15.35  Minnesota Rules, chapter 4630; 
 15.36     (19) mental health outpatient services for adults with 
 16.1   mental illness or children with emotional disturbance; 
 16.2      (20) residential programs serving school-age children whose 
 16.3   sole purpose is cultural or educational exchange, until the 
 16.4   commissioner adopts appropriate rules; 
 16.5      (21) unrelated individuals who provide out-of-home respite 
 16.6   care services to persons with mental retardation or related 
 16.7   conditions from a single related family for no more than 90 days 
 16.8   in a 12-month period and the respite care services are for the 
 16.9   temporary relief of the person's family or legal representative; 
 16.10     (22) respite care services provided as a home and 
 16.11  community-based service to a person with mental retardation or a 
 16.12  related condition, in the person's primary residence; 
 16.13     (23) community support services programs as defined in 
 16.14  section 245.462, subdivision 6, and family community support 
 16.15  services as defined in section 245.4871, subdivision 17; or 
 16.16     (24) the placement of a child by a birth parent or legal 
 16.17  guardian in a preadoptive home for purposes of adoption as 
 16.18  authorized by section 259.47; or 
 16.19     (25) settings registered under chapter 144D which provide 
 16.20  home care services licensed by the commissioner of health to 
 16.21  fewer than seven adults. 
 16.22     For purposes of clause (6), a building is directly 
 16.23  contiguous to a building in which a nonresidential program is 
 16.24  located if it shares a common wall with the building in which 
 16.25  the nonresidential program is located or is attached to that 
 16.26  building by skyway, tunnel, atrium, or common roof. 
 16.27     Sec. 17.  Minnesota Statutes 1996, section 256B.0913, 
 16.28  subdivision 5, is amended to read: 
 16.29     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
 16.30  Alternative care funding may be used for payment of costs of: 
 16.31     (1) adult foster care; 
 16.32     (2) adult day care; 
 16.33     (3) home health aide; 
 16.34     (4) homemaker services; 
 16.35     (5) personal care; 
 16.36     (6) case management; 
 17.1      (7) respite care; 
 17.2      (8) assisted living; 
 17.3      (9) residential care services; 
 17.4      (10) care-related supplies and equipment; 
 17.5      (11) meals delivered to the home; 
 17.6      (12) transportation; 
 17.7      (13) skilled nursing; 
 17.8      (14) chore services; 
 17.9      (15) companion services; 
 17.10     (16) nutrition services; 
 17.11     (17) training for direct informal caregivers; and 
 17.12     (18) telemedicine devices to monitor recipients in their 
 17.13  own homes as an alternative to hospital care, nursing home care, 
 17.14  or home visits. 
 17.15     (b) The county agency must ensure that the funds are used 
 17.16  only to supplement and not supplant services available through 
 17.17  other public assistance or services programs. 
 17.18     (c) Unless specified in statute, the service standards for 
 17.19  alternative care services shall be the same as the service 
 17.20  standards defined in the elderly waiver.  Persons or agencies 
 17.21  must be employed by or under a contract with the county agency 
 17.22  or the public health nursing agency of the local board of health 
 17.23  in order to receive funding under the alternative care program. 
 17.24     (d) The adult foster care rate shall be considered a 
 17.25  difficulty of care payment and shall not include room and 
 17.26  board.  The adult foster care daily rate shall be negotiated 
 17.27  between the county agency and the foster care provider.  The 
 17.28  rate established under this section shall not exceed 75 percent 
 17.29  of the state average monthly nursing home payment for the case 
 17.30  mix classification to which the individual receiving foster care 
 17.31  is assigned, and it must allow for other alternative care 
 17.32  services to be authorized by the case manager. 
 17.33     (e) Personal care services may be provided by a personal 
 17.34  care provider organization.  A county agency may contract with a 
 17.35  relative of the client to provide personal care services, but 
 17.36  must ensure nursing supervision.  Covered personal care services 
 18.1   defined in section 256B.0627, subdivision 4, must meet 
 18.2   applicable standards in Minnesota Rules, part 9505.0335. 
 18.3      (f) A county may use alternative care funds to purchase 
 18.4   medical supplies and equipment without prior approval from the 
 18.5   commissioner when:  (1) there is no other funding source; (2) 
 18.6   the supplies and equipment are specified in the individual's 
 18.7   care plan as medically necessary to enable the individual to 
 18.8   remain in the community according to the criteria in Minnesota 
 18.9   Rules, part 9505.0210, item A; and (3) the supplies and 
 18.10  equipment represent an effective and appropriate use of 
 18.11  alternative care funds.  A county may use alternative care funds 
 18.12  to purchase supplies and equipment from a non-Medicaid certified 
 18.13  vendor if the cost for the items is less than that of a Medicaid 
 18.14  vendor.  A county is not required to contract with a provider of 
 18.15  supplies and equipment if the monthly cost of the supplies and 
 18.16  equipment is less than $250.  
 18.17     (g) For purposes of this section, residential care services 
 18.18  are services which are provided to individuals living in 
 18.19  residential care homes.  Residential care homes are currently 
 18.20  licensed as board and lodging establishments and are registered 
 18.21  with the department of health as providing special services.  
 18.22  Residential care services are defined as "supportive services" 
 18.23  and "health-related services."  "Supportive services" means the 
 18.24  provision of up to 24-hour supervision and oversight.  
 18.25  Supportive services includes:  (1) transportation, when provided 
 18.26  by the residential care center only; (2) socialization, when 
 18.27  socialization is part of the plan of care, has specific goals 
 18.28  and outcomes established, and is not diversional or recreational 
 18.29  in nature; (3) assisting clients in setting up meetings and 
 18.30  appointments; (4) assisting clients in setting up medical and 
 18.31  social services; (5) providing assistance with personal laundry, 
 18.32  such as carrying the client's laundry to the laundry room.  
 18.33  Assistance with personal laundry does not include any laundry, 
 18.34  such as bed linen, that is included in the room and board rate.  
 18.35  Health-related services are limited to minimal assistance with 
 18.36  dressing, grooming, and bathing and providing reminders to 
 19.1   residents to take medications that are self-administered or 
 19.2   providing storage for medications, if requested.  Individuals 
 19.3   receiving residential care services cannot receive both personal 
 19.4   care services and residential care services.  
 19.5      (h) For the purposes of this section, "assisted living" 
 19.6   refers to supportive services provided by a single vendor to 
 19.7   clients who reside in the same apartment building of three or 
 19.8   more units which are not subject to registration under chapter 
 19.9   144D.  Assisted living services are defined as up to 24-hour 
 19.10  supervision, and oversight, supportive services as defined in 
 19.11  clause (1), individualized home care aide tasks as defined in 
 19.12  clause (2), and individualized home management tasks as defined 
 19.13  in clause (3) provided to residents of a residential center 
 19.14  living in their units or apartments with a full kitchen and 
 19.15  bathroom.  A full kitchen includes a stove, oven, refrigerator, 
 19.16  food preparation counter space, and a kitchen utensil storage 
 19.17  compartment.  Assisted living services must be provided by the 
 19.18  management of the residential center or by providers under 
 19.19  contract with the management or with the county. 
 19.20     (1) Supportive services include:  
 19.21     (i) socialization, when socialization is part of the plan 
 19.22  of care, has specific goals and outcomes established, and is not 
 19.23  diversional or recreational in nature; 
 19.24     (ii) assisting clients in setting up meetings and 
 19.25  appointments; and 
 19.26     (iii) providing transportation, when provided by the 
 19.27  residential center only.  
 19.28     Individuals receiving assisted living services will not 
 19.29  receive both assisted living services and homemaking or personal 
 19.30  care services.  Individualized means services are chosen and 
 19.31  designed specifically for each resident's needs, rather than 
 19.32  provided or offered to all residents regardless of their 
 19.33  illnesses, disabilities, or physical conditions.  
 19.34     (2) Home care aide tasks means:  
 19.35     (i) preparing modified diets, such as diabetic or low 
 19.36  sodium diets; 
 20.1      (ii) reminding residents to take regularly scheduled 
 20.2   medications or to perform exercises; 
 20.3      (iii) household chores in the presence of technically 
 20.4   sophisticated medical equipment or episodes of acute illness or 
 20.5   infectious disease; 
 20.6      (iv) household chores when the resident's care requires the 
 20.7   prevention of exposure to infectious disease or containment of 
 20.8   infectious disease; and 
 20.9      (v) assisting with dressing, oral hygiene, hair care, 
 20.10  grooming, and bathing, if the resident is ambulatory, and if the 
 20.11  resident has no serious acute illness or infectious disease.  
 20.12  Oral hygiene means care of teeth, gums, and oral prosthetic 
 20.13  devices.  
 20.14     (3) Home management tasks means:  
 20.15     (i) housekeeping; 
 20.16     (ii) laundry; 
 20.17     (iii) preparation of regular snacks and meals; and 
 20.18     (iv) shopping.  
 20.19     Assisted living services as defined in this section shall 
 20.20  not be authorized in boarding and lodging establishments 
 20.21  licensed according to sections 157.011 and 157.15 to 157.22. 
 20.22     (i) For establishments registered under chapter 144D, 
 20.23  assisted living services under this section means the services 
 20.24  described and licensed under section 144A.4605. 
 20.25     (j) For the purposes of this section, reimbursement for 
 20.26  assisted living services and residential care services shall be 
 20.27  a monthly rate negotiated and authorized by the county 
 20.28  agency based on an individualized service plan for each resident.
 20.29  The rate shall not exceed the nonfederal share of the greater of 
 20.30  either the statewide or any of the geographic groups' weighted 
 20.31  average monthly medical assistance nursing facility payment rate 
 20.32  of the case mix resident class to which the 180-day eligible 
 20.33  client would be assigned under Minnesota Rules, parts 9549.0050 
 20.34  to 9549.0059.  For alternative care assisted living projects 
 20.35  established under Laws 1988, chapter 689, article 2, section 
 20.36  256, monthly rates may not exceed 65 percent of the greater of 
 21.1   either statewide or any of the geographic groups' weighted 
 21.2   average monthly medical assistance nursing facility payment rate 
 21.3   of the case mix resident class to which the 180-day eligible 
 21.4   client would be assigned under Minnesota Rules, parts 9549.0050 
 21.5   to 9549.0059.  The rate may not cover rent and direct food 
 21.6   costs, unless the services are provided by a home care provider 
 21.7   licensed by the department of health and are provided in a 
 21.8   building that is registered as a housing with services 
 21.9   establishment under chapter 144D and that provides 24-hour 
 21.10  supervision. 
 21.11     (j) (k) For purposes of this section, companion services 
 21.12  are defined as nonmedical care, supervision and oversight, 
 21.13  provided to a functionally impaired adult.  Companions may 
 21.14  assist the individual with such tasks as meal preparation, 
 21.15  laundry and shopping, but do not perform these activities as 
 21.16  discrete services.  The provision of companion services does not 
 21.17  entail hands-on medical care.  Providers may also perform light 
 21.18  housekeeping tasks which are incidental to the care and 
 21.19  supervision of the recipient.  This service must be approved by 
 21.20  the case manager as part of the care plan.  Companion services 
 21.21  must be provided by individuals or nonprofit organizations who 
 21.22  are under contract with the local agency to provide the 
 21.23  service.  Any person related to the waiver recipient by blood, 
 21.24  marriage or adoption cannot be reimbursed under this service.  
 21.25  Persons providing companion services will be monitored by the 
 21.26  case manager. 
 21.27     (k) (l) For purposes of this section, training for direct 
 21.28  informal caregivers is defined as a classroom or home course of 
 21.29  instruction which may include:  transfer and lifting skills, 
 21.30  nutrition, personal and physical cares, home safety in a home 
 21.31  environment, stress reduction and management, behavioral 
 21.32  management, long-term care decision making, care coordination 
 21.33  and family dynamics.  The training is provided to an informal 
 21.34  unpaid caregiver of a 180-day eligible client which enables the 
 21.35  caregiver to deliver care in a home setting with high levels of 
 21.36  quality.  The training must be approved by the case manager as 
 22.1   part of the individual care plan.  Individuals, agencies, and 
 22.2   educational facilities which provide caregiver training and 
 22.3   education will be monitored by the case manager. 
 22.4      Sec. 18.  Minnesota Statutes 1996, section 256B.0915, 
 22.5   subdivision 3, is amended to read: 
 22.6      Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 
 22.7   FORECASTING.] (a) The number of medical assistance waiver 
 22.8   recipients that a county may serve must be allocated according 
 22.9   to the number of medical assistance waiver cases open on July 1 
 22.10  of each fiscal year.  Additional recipients may be served with 
 22.11  the approval of the commissioner. 
 22.12     (b) The monthly limit for the cost of waivered services to 
 22.13  an individual waiver client shall be the statewide average 
 22.14  payment rate of the case mix resident class to which the waiver 
 22.15  client would be assigned under the medical assistance case mix 
 22.16  reimbursement system.  If medical supplies and equipment or 
 22.17  adaptations are or will be purchased for an elderly waiver 
 22.18  services recipient, the costs may be prorated on a monthly basis 
 22.19  throughout the year in which they are purchased.  If the monthly 
 22.20  cost of a recipient's other waivered services exceeds the 
 22.21  monthly limit established in this paragraph, the annual cost of 
 22.22  the waivered services shall be determined.  In this event, the 
 22.23  annual cost of waivered services shall not exceed 12 times the 
 22.24  monthly limit calculated in this paragraph.  The statewide 
 22.25  average payment rate is calculated by determining the statewide 
 22.26  average monthly nursing home rate, effective July 1 of the 
 22.27  fiscal year in which the cost is incurred, less the statewide 
 22.28  average monthly income of nursing home residents who are age 65 
 22.29  or older, and who are medical assistance recipients in the month 
 22.30  of March of the previous state fiscal year.  The annual cost 
 22.31  divided by 12 of elderly or disabled waivered services for a 
 22.32  person who is a nursing facility resident at the time of 
 22.33  requesting a determination of eligibility for elderly or 
 22.34  disabled waivered services shall not exceed the monthly payment 
 22.35  for the resident class assigned under Minnesota Rules, parts 
 22.36  9549.0050 to 9549.0059, for that resident in the nursing 
 23.1   facility where the resident currently resides.  The following 
 23.2   costs must be included in determining the total monthly costs 
 23.3   for the waiver client: 
 23.4      (1) cost of all waivered services, including extended 
 23.5   medical supplies and equipment; and 
 23.6      (2) cost of skilled nursing, home health aide, and personal 
 23.7   care services reimbursable by medical assistance.  
 23.8      (c) Medical assistance funding for skilled nursing 
 23.9   services, private duty nursing, home health aide, and personal 
 23.10  care services for waiver recipients must be approved by the case 
 23.11  manager and included in the individual care plan. 
 23.12     (d) For both the elderly waiver and the nursing facility 
 23.13  disabled waiver, a county may purchase extended supplies and 
 23.14  equipment without prior approval from the commissioner when 
 23.15  there is no other funding source and the supplies and equipment 
 23.16  are specified in the individual's care plan as medically 
 23.17  necessary to enable the individual to remain in the community 
 23.18  according to the criteria in Minnesota Rules, part 9505.0210, 
 23.19  items A and B.  A county is not required to contract with a 
 23.20  provider of supplies and equipment if the monthly cost of the 
 23.21  supplies and equipment is less than $250.  
 23.22     (e) For the fiscal year beginning on July 1, 1993, and for 
 23.23  subsequent fiscal years, the commissioner of human services 
 23.24  shall not provide automatic annual inflation adjustments for 
 23.25  home and community-based waivered services.  The commissioner of 
 23.26  finance shall include as a budget change request in each 
 23.27  biennial detailed expenditure budget submitted to the 
 23.28  legislature under section 16A.11, annual adjustments in 
 23.29  reimbursement rates for home and community-based waivered 
 23.30  services, based on the forecasted percentage change in the Home 
 23.31  Health Agency Market Basket of Operating Costs, for the fiscal 
 23.32  year beginning July 1, compared to the previous fiscal year, 
 23.33  unless otherwise adjusted by statute.  The Home Health Agency 
 23.34  Market Basket of Operating Costs is published by Data Resources, 
 23.35  Inc.  The forecast to be used is the one published for the 
 23.36  calendar quarter beginning January 1, six months prior to the 
 24.1   beginning of the fiscal year for which rates are set.  The adult 
 24.2   foster care rate shall be considered a difficulty of care 
 24.3   payment and shall not include room and board. 
 24.4      (f) The adult foster care daily rate for the elderly and 
 24.5   disabled waivers shall be negotiated between the county agency 
 24.6   and the foster care provider.  The rate established under this 
 24.7   section shall not exceed the state average monthly nursing home 
 24.8   payment for the case mix classification to which the individual 
 24.9   receiving foster care is assigned; the rate must allow for other 
 24.10  waiver and medical assistance home care services to be 
 24.11  authorized by the case manager. 
 24.12     (g) The assisted living and residential care service rates 
 24.13  for elderly and community alternatives for disabled individuals 
 24.14  (CADI) waivers shall be made to the vendor as a monthly rate 
 24.15  negotiated with the county agency based on an individualized 
 24.16  service plan for each resident.  The rate shall not exceed the 
 24.17  nonfederal share of the greater of either the statewide or any 
 24.18  of the geographic groups' weighted average monthly medical 
 24.19  assistance nursing facility payment rate of the case mix 
 24.20  resident class to which the elderly or disabled client would be 
 24.21  assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, 
 24.22  unless the services are provided by a home care provider 
 24.23  licensed by the department of health and are provided in a 
 24.24  building that is registered as a housing with services 
 24.25  establishment under chapter 144D and that provides 24-hour 
 24.26  supervision.  For alternative care assisted living projects 
 24.27  established under Laws 1988, chapter 689, article 2, section 
 24.28  256, monthly rates may not exceed 65 percent of the greater of 
 24.29  either the statewide or any of the geographic groups' weighted 
 24.30  average monthly medical assistance nursing facility payment rate 
 24.31  for the case mix resident class to which the elderly or disabled 
 24.32  client would be assigned under Minnesota Rules, parts 9549.0050 
 24.33  to 9549.0059.  The rate may not cover direct rent or food costs. 
 24.34     (h) The county shall negotiate individual rates with 
 24.35  vendors and may be reimbursed for actual costs up to the greater 
 24.36  of the county's current approved rate or 60 percent of the 
 25.1   maximum rate in fiscal year 1994 and 65 percent of the maximum 
 25.2   rate in fiscal year 1995 for each service within each program. 
 25.3      (i) On July 1, 1993, the commissioner shall increase the 
 25.4   maximum rate for home-delivered meals to $4.50 per meal. 
 25.5      (j) Reimbursement for the medical assistance recipients 
 25.6   under the approved waiver shall be made from the medical 
 25.7   assistance account through the invoice processing procedures of 
 25.8   the department's Medicaid Management Information System (MMIS), 
 25.9   only with the approval of the client's case manager.  The budget 
 25.10  for the state share of the Medicaid expenditures shall be 
 25.11  forecasted with the medical assistance budget, and shall be 
 25.12  consistent with the approved waiver.  
 25.13     (k) Beginning July 1, 1991, the state shall reimburse 
 25.14  counties according to the payment schedule in section 256.025 
 25.15  for the county share of costs incurred under this subdivision on 
 25.16  or after January 1, 1991, for individuals who are receiving 
 25.17  medical assistance. 
 25.18     Sec. 19.  Minnesota Statutes 1996, section 256I.04, 
 25.19  subdivision 2a, is amended to read: 
 25.20     Subd. 2a.  [LICENSE REQUIRED.] A county agency may not 
 25.21  enter into an agreement with an establishment to provide group 
 25.22  residential housing unless:  
 25.23     (1) the establishment is licensed by the department of 
 25.24  health as a hotel and restaurant; a board and lodging 
 25.25  establishment; a residential care home; a boarding care home 
 25.26  before March 1, 1985; or a supervised living facility, and the 
 25.27  service provider for residents of the facility is licensed under 
 25.28  chapter 245A.  However, an establishment licensed by the 
 25.29  department of health to provide lodging need not also be 
 25.30  licensed to provide board if meals are being supplied to 
 25.31  residents under a contract with a food vendor who is licensed by 
 25.32  the department of health; or 
 25.33     (2) the residence is licensed by the commissioner of human 
 25.34  services under Minnesota Rules, parts 9555.5050 to 9555.6265, or 
 25.35  certified by a county human services agency prior to July 1, 
 25.36  1992, using the standards under Minnesota Rules, parts 9555.5050 
 26.1   to 9555.6265; or 
 26.2      (3) the establishment is registered under chapter 144D and 
 26.3   provides three meals a day. 
 26.4      The requirements under clauses (1) and, (2), and (3) do not 
 26.5   apply to establishments exempt from state licensure because they 
 26.6   are located on Indian reservations and subject to tribal health 
 26.7   and safety requirements. 
 26.8      Sec. 20.  Minnesota Statutes 1996, section 462.357, 
 26.9   subdivision 7, is amended to read: 
 26.10     Subd. 7.  [PERMITTED SINGLE FAMILY USE.] A state licensed 
 26.11  residential facility or a housing with services establishment 
 26.12  registered under chapter 144D serving six or fewer persons, a 
 26.13  licensed day care facility serving 12 or fewer persons, and a 
 26.14  group family day care facility licensed under Minnesota Rules, 
 26.15  parts 9502.0315 to 9502.0445 to serve 14 or fewer children shall 
 26.16  be considered a permitted single family residential use of 
 26.17  property for the purposes of zoning, except that a residential 
 26.18  facility whose primary purpose is to treat juveniles who have 
 26.19  violated criminal statutes relating to sex offenses or have been 
 26.20  adjudicated delinquent on the basis of conduct in violation of 
 26.21  criminal statutes relating to sex offenses shall not be 
 26.22  considered a permitted use. 
 26.23     Sec. 21.  [STUDY OF NURSING HOME PROVISION OF HOME CARE 
 26.24  SERVICES.] 
 26.25     The commissioner of health shall perform a study to 
 26.26  determine the most appropriate and cost-effective way to enable 
 26.27  licensing nursing home and boarding care home providers to use 
 26.28  their existing pool of trained staff to provide home care 
 26.29  services in a housing with services establishment registered 
 26.30  according to Minnesota Statutes, chapter 144D, that is attached 
 26.31  to or located on property contiguous to the nursing home or 
 26.32  boarding care home.  The study shall evaluate comparability of 
 26.33  current home care licensing, enforcement, and quality assurance 
 26.34  provisions with alternative regulatory structures, including but 
 26.35  not limited to private contracts, home care license options, and 
 26.36  nursing home license options.  The commissioner shall convene an 
 27.1   advisory group that is representative of the affected parties to 
 27.2   advise the department of the feasibility of proposed options.  
 27.3   The commissioner shall submit a report to the chairs of the 
 27.4   senate health and family security committee and the house of 
 27.5   representatives health and human services committee no later 
 27.6   than January 15, 1998. 
 27.7      Sec. 22.  [REPEALER.] 
 27.8      Minnesota Statutes 1996, sections 144A.45, subdivision 3; 
 27.9   144A.49; 144B.01; 144B.02; 144B.03; 144B.04; 144B.05; 144B.06; 
 27.10  144B.07; 144B.08; 144B.09; 144B.10; 144B.11; 144B.12; 144B.13; 
 27.11  144B.14; 144B.15; 144B.16; and 144B.17, are repealed.