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. 
  5.32     (c) The commissioner shall not issue a license to a home 
  5.33  care provider if an owner or managerial official includes any 
  5.34  individual who was an owner or managerial official of a home 
  5.35  care provider whose Minnesota license was not renewed or was 
  5.36  revoked as described in paragraph (b) for five years following 
  6.1   the effective date of nonrenewal or revocation. 
  6.2      (d) Notwithstanding the provisions of paragraph (a), the 
  6.3   commissioner shall not renew, or shall suspend or revoke the 
  6.4   license of any home care provider which includes any individual 
  6.5   as an owner or managerial official who was an owner or 
  6.6   managerial official of a home care provider whose Minnesota 
  6.7   license was not renewed or was revoked as described in paragraph 
  6.8   (b) for five years following the effective date of the 
  6.9   nonrenewal or revocation.  The commissioner shall notify the 
  6.10  home care provider 30 days in advance of the date of nonrenewal, 
  6.11  suspension, or revocation of the license.  Within ten days after 
  6.12  the receipt of this notification, the home care provider may 
  6.13  request, in writing, that the commissioner stay the nonrenewal, 
  6.14  revocation, or suspension of the license.  The home care 
  6.15  provider shall specify the reasons for requesting the stay; the 
  6.16  steps that will be taken to attain or maintain compliance with 
  6.17  the licensure laws and regulations; any limits on the authority 
  6.18  or responsibility of the owners or managerial officials whose 
  6.19  actions resulted in the notice of nonrenewal, revocation, or 
  6.20  suspension; and any other information to establish that the 
  6.21  continuing affiliation with these individuals will not 
  6.22  jeopardize client health, safety or well being.  The 
  6.23  commissioner shall determine whether the stay will be granted 
  6.24  within 30 days of receiving the provider's request.  The 
  6.25  commissioner may propose additional restrictions or limitations 
  6.26  on the provider's license and require that the granting of the 
  6.27  stay be contingent upon compliance with those provisions.  The 
  6.28  commissioner shall take into consideration the following factors 
  6.29  when determining whether the stay should be granted: 
  6.30     (1) the threat that continued involvement of the owners and 
  6.31  managerial officials in the home care provider poses to client 
  6.32  health, safety and well being; 
  6.33     (2) the compliance history of the home care provider; and 
  6.34     (3) the appropriateness of any limits suggested by the home 
  6.35  care provider. 
  6.36  If the commissioner grants the stay, the order shall include any 
  7.1   restrictions or limitation on the provider's license.  The 
  7.2   failure of the provider to comply with any restrictions or 
  7.3   limitations shall result in the immediate removal of the stay 
  7.4   and the commissioner shall take immediate action to suspend, 
  7.5   revoke or not renew the license. 
  7.6      (e) The provisions contained in paragraphs (b) and (c) 
  7.7   shall apply to any nonrenewal or revocation of a home care 
  7.8   license occurring after June 1, 1993, the effective date of the 
  7.9   home care licensure rules. 
  7.10     (f) For the purposes of this subdivision, owners of a home 
  7.11  care provider are those individuals whose ownership interest 
  7.12  provides sufficient authority or control to affect or change 
  7.13  decisions related to the operation of the home care provider.  
  7.14  An owner includes a sole proprietor, a general partner, or any 
  7.15  other individual whose individual ownership interest can affect 
  7.16  the management and direction of the policies of the home care 
  7.17  provider.  For the purposes of this subdivision, managerial 
  7.18  officials are those individuals who had the responsibility for 
  7.19  the ongoing management or direction of the policies, services or 
  7.20  employees of the home care provider relating to the areas of 
  7.21  noncompliance which led to the license revocation or nonrenewal. 
  7.22     Sec. 6.  [144A.4605] [ASSISTED LIVING HOME CARE PROVIDER.] 
  7.23     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  7.24  section, the term "assisted living home care provider" means a 
  7.25  home care provider who provides nursing services, delegated 
  7.26  nursing services, other services performed by unlicensed 
  7.27  personnel, or central storage of medications solely for 
  7.28  residents of one or more housing with services establishments 
  7.29  registered under chapter 144D. 
  7.30     Subd. 2.  [ASSISTED LIVING HOME CARE LICENSE 
  7.31  ESTABLISHED.] A home care provider license category entitled 
  7.32  assisted living home care provider is hereby established.  A 
  7.33  home care provider may obtain an assisted living license if the 
  7.34  program meets the following requirements: 
  7.35     (a) nursing services, delegated nursing services, other 
  7.36  services performed by unlicensed personnel, or central storage 
  8.1   of medications under the assisted living license are provided 
  8.2   solely for residents of one or more housing with services 
  8.3   establishments registered under chapter 144D; 
  8.4      (b) unlicensed personnel perform home health aide and home 
  8.5   care aide tasks identified in Minnesota Rules, parts 4668.0100, 
  8.6   subparts 1 and 2, and 4668.0110, subpart 1.  Qualifications to 
  8.7   perform these tasks shall be established in accordance with 
  8.8   subdivision 3; 
  8.9      (c) periodic supervision of unlicensed personnel is 
  8.10  provided as required by rule; 
  8.11     (d) notwithstanding Minnesota Rules, part 4668.0160, 
  8.12  subpart 6, item D, client records shall include: 
  8.13     (1) a weekly summary of the client's status and home care 
  8.14  services provided; 
  8.15     (2) documentation each time medications are administered to 
  8.16  a client; and 
  8.17     (3) documentation on the day of occurrence of any 
  8.18  significant change in the client's status or any significant 
  8.19  incident, such as a fall or refusal to take medications. 
  8.20     All entries must be signed by the staff providing the 
  8.21  services and entered into the record no later than two weeks 
  8.22  after the end of the service day, except as specified in clauses 
  8.23  (2) and (3); 
  8.24     (e) medication and treatment orders, if any, are included 
  8.25  in the client record and are renewed at least every 12 months, 
  8.26  or more frequently when indicated by a clinical assessment; 
  8.27     (f) the central storage of medications in a housing with 
  8.28  services establishment registered under chapter 144D is managed 
  8.29  under a system that is established by a registered nurse and 
  8.30  addresses the control of medications, handling of medications, 
  8.31  medication containers, medication records, and disposition of 
  8.32  medications; and 
  8.33     (g) in other respects meets the requirements established by 
  8.34  rules adopted under sections 144A.45 to 144A.48. 
  8.35     Subd. 3.  [TRAINING OR COMPETENCY EVALUATIONS REQUIRED.] (a)
  8.36  Unlicensed personnel must: 
  9.1      (1) satisfy the training or competency requirements 
  9.2   established by rule under sections 144A.45 to 144A.48; or 
  9.3      (2) be trained or determined competent by a registered 
  9.4   nurse in each task identified under Minnesota Rules, part 
  9.5   4668.0100, subparts 1 and 2, when offered to clients in a 
  9.6   housing with services establishment as described in paragraphs 
  9.7   (b) to (e). 
  9.8      (b) Training for tasks identified under Minnesota Rules, 
  9.9   part 4668.0100, subparts 1 and 2, shall use a curriculum which 
  9.10  meets the requirements in Minnesota Rules, part 4668.0130. 
  9.11     (c) Competency evaluations for tasks identified under 
  9.12  Minnesota Rules, part 4668.0100, subparts 1 and 2, must be 
  9.13  completed and documented by a registered nurse. 
  9.14     (d) Unlicensed personnel performing tasks identified under 
  9.15  Minnesota Rules, part 4668.0100, subparts 1 and 2, shall be 
  9.16  trained or demonstrate competency in the following topics: 
  9.17     (1) an overview of sections 144A.43 to 144A.49 and rules 
  9.18  adopted thereunder; 
  9.19     (2) recognition and handling of emergencies and use of 
  9.20  emergency services; 
  9.21     (3) reporting the maltreatment of vulnerable minors or 
  9.22  adults under sections 626.556 and 626.557; 
  9.23     (4) home care bill of rights; 
  9.24     (5) handling of clients' complaints and reporting of 
  9.25  complaints to the office of health facility complaints; 
  9.26     (6) services of the ombudsman for older Minnesotans; 
  9.27     (7) observation, reporting, and documentation of client 
  9.28  status and of the care or services provided; 
  9.29     (8) basic infection control; 
  9.30     (9) maintenance of a clean, safe, and healthy environment; 
  9.31     (10) communication skills; 
  9.32     (11) basic elements of body functioning and changes in body 
  9.33  function that must be reported to an appropriate health care 
  9.34  professional; and 
  9.35     (12) physical, emotional, and developmental needs of 
  9.36  clients, and ways to work with clients who have problems in 
 10.1   these areas, including respect for the client, the client's 
 10.2   property, and the client's family. 
 10.3      (e) Unlicensed personnel who administer medications must 
 10.4   comply with rules relating to the administration of medications 
 10.5   in Minnesota Rules, part 4668.0100, subpart 2, except that 
 10.6   unlicensed personnel need not comply with the requirements of 
 10.7   Minnesota Rules, part 4668.0100, subpart 5. 
 10.8      Subd. 4.  [LICENSE REQUIRED.] (a) A housing with services 
 10.9   establishment registered under chapter 144D that is required to 
 10.10  obtain a home care license must obtain an assisted living home 
 10.11  care license according to this section or a class A license 
 10.12  according to rule. 
 10.13     (b) A board and lodging establishment registered for 
 10.14  special services as of December 31, 1996, and also registered as 
 10.15  a housing with services establishment under chapter 144D, must 
 10.16  deliver home care services according to sections 144A.43 to 
 10.17  144A.49, and may apply for a waiver from requirements under 
 10.18  Minnesota Rules, parts 4668.0002 to 4668.0240, to operate a 
 10.19  licensed agency under the standards of section 157.17.  Such 
 10.20  waivers as may be granted by the department will expire upon 
 10.21  promulgation of home care rules implementing section 144A.4605. 
 10.22     (c) An adult foster care provider licensed by the 
 10.23  department of human services and registered under chapter 144D 
 10.24  may continue to provide health-related services under its foster 
 10.25  care license until the promulgation of home care rules 
 10.26  implementing this section. 
 10.27     Subd. 5.  [LICENSE FEES.] The license fees for assisted 
 10.28  living home care providers shall be as follows: 
 10.29     (1) $125 annually for those providers serving a monthly 
 10.30  average of 15 or fewer clients, and for assisted living 
 10.31  providers of all sizes during the first year of operation; 
 10.32     (2) $200 annually for those providers serving a monthly 
 10.33  average of 16 to 30 clients; 
 10.34     (3) $375 annually for those providers serving a monthly 
 10.35  average of 31 to 50 clients; and 
 10.36     (4) $625 annually for those providers serving a monthly 
 11.1   average of 50 or more clients. 
 11.2      Subd. 6.  [WAIVER.] Upon request of the home care provider, 
 11.3   the commissioner may waive the provisions of this section 
 11.4   relating to registered nurse duties. 
 11.5      Sec. 7.  Minnesota Statutes 1996, section 144D.01, 
 11.6   subdivision 4, is amended to read: 
 11.7      Subd. 4.  [ELDERLY HOUSING WITH SERVICES ESTABLISHMENT OR 
 11.8   ESTABLISHMENT.] "Elderly Housing with services establishment" or 
 11.9   "establishment" means an establishment providing sleeping 
 11.10  accommodations to one or more adult residents, at least 80 
 11.11  percent of which are 55 years of age or older, and offering or 
 11.12  providing, for a fee, one or more regularly scheduled 
 11.13  health-related services or two or more regularly scheduled 
 11.14  supportive service services, whether offered or provided 
 11.15  directly by the establishment or by another entity arranged for 
 11.16  by the establishment. 
 11.17     Elderly Housing with services establishment does not 
 11.18  include: 
 11.19     (1) a nursing home licensed under chapter 144A; 
 11.20     (2) a hospital, boarding care home, or supervised living 
 11.21  facility licensed under sections 144.50 to 144.56; 
 11.22     (3) a board and lodging establishment licensed under 
 11.23  chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670, 
 11.24  9525.0215 to 9525.0355, 9525.0500 to 9525.0660, or 9530.4100 to 
 11.25  9530.4450; 
 11.26     (4) a board and lodging establishment which serves as a 
 11.27  shelter for battered women or other similar purpose; 
 11.28     (5) a family adult foster care home licensed under 
 11.29  Minnesota Rules, parts 9543.0010 to 9543.0150 by the department 
 11.30  of human services; or 
 11.31     (6) private homes in which the residents are related by 
 11.32  kinship, law, or affinity with the providers of services; 
 11.33     (7) a home-sharing arrangement such as when an elderly or 
 11.34  disabled person or single-parent family makes lodging in a 
 11.35  private residence available to another person in exchange for 
 11.36  services or rent, or both; 
 12.1      (8) a duly organized condominium, cooperative, common 
 12.2   interest community, or owners' association of the foregoing 
 12.3   where at least 80 percent of the units that comprise the 
 12.4   condominium, cooperative, or common interest community are 
 12.5   occupied by individuals who are the owners, members, or 
 12.6   shareholders of the units; or 
 12.7      (9) services for persons with developmental disabilities 
 12.8   that are provided under a license according to Minnesota Rules, 
 12.9   parts 9525.2000 to 9525.2140. 
 12.10     Sec. 8.  Minnesota Statutes 1996, section 144D.01, 
 12.11  subdivision 5, is amended to read: 
 12.12     Subd. 5.  [SUPPORTIVE SERVICES.] "Supportive services" 
 12.13  means arranging for medical services, health-related services, 
 12.14  social services, transportation, help with personal laundry, or 
 12.15  handling or assisting with personal funds of residents, or 
 12.16  arranging for medical services, health-related services, social 
 12.17  services, or transportation to medical or social services 
 12.18  appointments.  Arranging for services does not include making 
 12.19  referrals, assisting a resident in contacting a service provider 
 12.20  of the resident's choice, or contacting a service provider in an 
 12.21  emergency. 
 12.22     Sec. 9.  Minnesota Statutes 1996, section 144D.01, 
 12.23  subdivision 6, is amended to read: 
 12.24     Subd. 6.  [HEALTH-RELATED SERVICES.] "Health-related 
 12.25  services" include professional nursing services, home health 
 12.26  aide tasks, and home care aide tasks identified in Minnesota 
 12.27  Rules, parts 4668.0100, subparts 1 and 2; and 4668.0110, subpart 
 12.28  1,; or the central storage of medication for residents under 
 12.29  section 144A.485, subdivision 2, clause (6). 
 12.30     Sec. 10.  Minnesota Statutes 1996, section 144D.01, is 
 12.31  amended by adding a subdivision to read: 
 12.32     Subd. 7.  [FAMILY ADULT FOSTER CARE HOME.] "Family adult 
 12.33  foster care home" means an adult foster care home that is 
 12.34  licensed by the department of human services, that is the 
 12.35  primary residence of the license holder, and in which the 
 12.36  license holder is the primary caregiver. 
 13.1      Sec. 11.  Minnesota Statutes 1996, section 144D.03, 
 13.2   subdivision 1, is amended to read: 
 13.3      Subdivision 1.  [REGISTRATION PROCEDURES.] The commissioner 
 13.4   shall establish forms and procedures for annual registration 
 13.5   of elderly housing with services establishments.  The 
 13.6   commissioner shall charge an annual registration fee of $35.  No 
 13.7   fee shall be refunded.  A registered establishment shall notify 
 13.8   the commissioner within 30 days of the date it is no longer 
 13.9   required to be registered under this chapter or of any change in 
 13.10  the business name or address of the establishment, the name or 
 13.11  mailing address of the owner or owners, or the name or mailing 
 13.12  address of the managing agent.  There shall be no fee for 
 13.13  submission of the notice. 
 13.14     Sec. 12.  [144D.035] [RESTRAINTS.] 
 13.15     Residents must be free from any physical or chemical 
 13.16  restraints imposed for purposes of discipline or convenience. 
 13.17     Sec. 13.  Minnesota Statutes 1996, section 144D.06, is 
 13.18  amended to read: 
 13.19     144D.06 [OTHER LAWS.] 
 13.20     An elderly A housing with services establishment shall 
 13.21  obtain and maintain all other licenses, permits, registrations, 
 13.22  or other governmental approvals required of it in addition to 
 13.23  registration under this chapter, except that an establishment 
 13.24  registered under this chapter is exempt, at its option, from the 
 13.25  requirement of obtaining and maintaining an adult foster care 
 13.26  license under Minnesota Rules, parts 9543.0010 to 9543.0150, or 
 13.27  a lodging license under chapter 157.  An elderly.  A housing 
 13.28  with services establishment is subject to the provisions of 
 13.29  sections 504.01 to 504.28 and 566.01 to 566.175.  An elderly 
 13.30  housing with services establishment which is also described in 
 13.31  section 157.17 is exempt from the requirements of that section 
 13.32  while it is registered under this chapter. 
 13.33     Sec. 14.  Minnesota Statutes 1996, section 157.17, 
 13.34  subdivision 2, is amended to read: 
 13.35     Subd. 2.  [REGISTRATION.] At the time of licensure or 
 13.36  license renewal, a boarding and lodging establishment or a 
 14.1   lodging establishment that provides supportive services or 
 14.2   health supervision services must be registered with the 
 14.3   commissioner, and must register annually thereafter.  The 
 14.4   registration must include the name, address, and telephone 
 14.5   number of the establishment, the name of the operator, the types 
 14.6   of services that are being provided, a description of the 
 14.7   residents being served, the type and qualifications of staff in 
 14.8   the facility, and other information that is necessary to 
 14.9   identify the needs of the residents and the types of services 
 14.10  that are being provided.  The commissioner shall develop and 
 14.11  furnish to the boarding and lodging establishment or lodging 
 14.12  establishment the necessary form for submitting the 
 14.13  registration.  The requirement for registration is effective 
 14.14  until the rules required by sections 144B.01 to 144B.17 are 
 14.15  effective. 
 14.16     Housing with services establishments registered under 
 14.17  chapter 144D shall be considered registered under this section 
 14.18  for all purposes except that: 
 14.19     (1) the establishments shall operate under the requirements 
 14.20  of chapter 144D; and 
 14.21     (2) the criminal background check requirements of sections 
 14.22  299C.66 to 299C.71 apply.  The criminal background check 
 14.23  requirements of section 144.057 apply only to personnel 
 14.24  providing home care services under sections 144A.43 to 144A.48. 
 14.25     Sec. 15.  Minnesota Statutes 1996, section 157.17, 
 14.26  subdivision 5, is amended to read: 
 14.27     Subd. 5.  [SERVICES THAT MAY NOT BE PROVIDED IN A BOARDING 
 14.28  AND LODGING ESTABLISHMENT OR LODGING ESTABLISHMENT.] Except 
 14.29  those facilities registered under chapter 144D, a boarding and 
 14.30  lodging establishment or lodging establishment may not admit or 
 14.31  retain individuals who: 
 14.32     (1) would require assistance from establishment staff 
 14.33  because of the following needs:  bowel incontinence, catheter 
 14.34  care, use of injectable or parenteral medications, wound care, 
 14.35  or dressing changes or irrigations of any kind; or 
 14.36     (2) require a level of care and supervision beyond 
 15.1   supportive services or health supervision services. 
 15.2      Sec. 16.  Minnesota Statutes 1996, section 245A.03, 
 15.3   subdivision 2, is amended to read: 
 15.4      Subd. 2.  [EXCLUSION FROM LICENSURE.] Sections 245A.01 to 
 15.5   245A.16 do not apply to: 
 15.6      (1) residential or nonresidential programs that are 
 15.7   provided to a person by an individual who is related unless the 
 15.8   residential program is a foster care placement made by a local 
 15.9   social services agency or a licensed child-placing agency, 
 15.10  except as provided in subdivision 2a; 
 15.11     (2) nonresidential programs that are provided by an 
 15.12  unrelated individual to persons from a single related family; 
 15.13     (3) residential or nonresidential programs that are 
 15.14  provided to adults who do not abuse chemicals or who do not have 
 15.15  a chemical dependency, a mental illness, mental retardation or a 
 15.16  related condition, a functional impairment, or a physical 
 15.17  handicap; 
 15.18     (4) sheltered workshops or work activity programs that are 
 15.19  certified by the commissioner of economic security; 
 15.20     (5) programs for children enrolled in kindergarten to the 
 15.21  12th grade and prekindergarten special education in a school as 
 15.22  defined in section 120.101, subdivision 4, and programs serving 
 15.23  children in combined special education and regular 
 15.24  prekindergarten programs that are operated or assisted by the 
 15.25  commissioner of children, families, and learning; 
 15.26     (6) nonresidential programs primarily for children that 
 15.27  provide care or supervision, without charge for ten or fewer 
 15.28  days a year, and for periods of less than three hours a day 
 15.29  while the child's parent or legal guardian is in the same 
 15.30  building as the nonresidential program or present within another 
 15.31  building that is directly contiguous to the building in which 
 15.32  the nonresidential program is located; 
 15.33     (7) nursing homes or hospitals licensed by the commissioner 
 15.34  of health except as specified under section 245A.02; 
 15.35     (8) board and lodge facilities licensed by the commissioner 
 15.36  of health that provide services for five or more persons whose 
 16.1   primary diagnosis is mental illness who have refused an 
 16.2   appropriate residential program offered by a county agency.  
 16.3   This exclusion expires on July 1, 1990; 
 16.4      (9) homes providing programs for persons placed there by a 
 16.5   licensed agency for legal adoption, unless the adoption is not 
 16.6   completed within two years; 
 16.7      (10) programs licensed by the commissioner of corrections; 
 16.8      (11) recreation programs for children or adults that 
 16.9   operate for fewer than 40 calendar days in a calendar year; 
 16.10     (12) programs operated by a school as defined in section 
 16.11  120.101, subdivision 4, whose primary purpose is to provide 
 16.12  child care to school-age children, provided the program is 
 16.13  approved by the district's school board; 
 16.14     (13) head start nonresidential programs which operate for 
 16.15  less than 31 days in each calendar year; 
 16.16     (14) noncertified boarding care homes unless they provide 
 16.17  services for five or more persons whose primary diagnosis is 
 16.18  mental illness or mental retardation; 
 16.19     (15) nonresidential programs for nonhandicapped children 
 16.20  provided for a cumulative total of less than 30 days in any 
 16.21  12-month period; 
 16.22     (16) residential programs for persons with mental illness, 
 16.23  that are located in hospitals, until the commissioner adopts 
 16.24  appropriate rules; 
 16.25     (17) the religious instruction of school-age children; 
 16.26  Sabbath or Sunday schools; or the congregate care of children by 
 16.27  a church, congregation, or religious society during the period 
 16.28  used by the church, congregation, or religious society for its 
 16.29  regular worship; 
 16.30     (18) camps licensed by the commissioner of health under 
 16.31  Minnesota Rules, chapter 4630; 
 16.32     (19) mental health outpatient services for adults with 
 16.33  mental illness or children with emotional disturbance; 
 16.34     (20) residential programs serving school-age children whose 
 16.35  sole purpose is cultural or educational exchange, until the 
 16.36  commissioner adopts appropriate rules; 
 17.1      (21) unrelated individuals who provide out-of-home respite 
 17.2   care services to persons with mental retardation or related 
 17.3   conditions from a single related family for no more than 90 days 
 17.4   in a 12-month period and the respite care services are for the 
 17.5   temporary relief of the person's family or legal representative; 
 17.6      (22) respite care services provided as a home and 
 17.7   community-based service to a person with mental retardation or a 
 17.8   related condition, in the person's primary residence; 
 17.9      (23) community support services programs as defined in 
 17.10  section 245.462, subdivision 6, and family community support 
 17.11  services as defined in section 245.4871, subdivision 17; or 
 17.12     (24) the placement of a child by a birth parent or legal 
 17.13  guardian in a preadoptive home for purposes of adoption as 
 17.14  authorized by section 259.47; or 
 17.15     (25) settings registered under chapter 144D which provide 
 17.16  home care services licensed by the commissioner of health to 
 17.17  fewer than seven adults. 
 17.18     For purposes of clause (6), a building is directly 
 17.19  contiguous to a building in which a nonresidential program is 
 17.20  located if it shares a common wall with the building in which 
 17.21  the nonresidential program is located or is attached to that 
 17.22  building by skyway, tunnel, atrium, or common roof. 
 17.23     Sec. 17.  Minnesota Statutes 1996, section 256B.0913, 
 17.24  subdivision 5, is amended to read: 
 17.25     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
 17.26  Alternative care funding may be used for payment of costs of: 
 17.27     (1) adult foster care; 
 17.28     (2) adult day care; 
 17.29     (3) home health aide; 
 17.30     (4) homemaker services; 
 17.31     (5) personal care; 
 17.32     (6) case management; 
 17.33     (7) respite care; 
 17.34     (8) assisted living; 
 17.35     (9) residential care services; 
 17.36     (10) care-related supplies and equipment; 
 18.1      (11) meals delivered to the home; 
 18.2      (12) transportation; 
 18.3      (13) skilled nursing; 
 18.4      (14) chore services; 
 18.5      (15) companion services; 
 18.6      (16) nutrition services; 
 18.7      (17) training for direct informal caregivers; and 
 18.8      (18) telemedicine devices to monitor recipients in their 
 18.9   own homes as an alternative to hospital care, nursing home care, 
 18.10  or home visits. 
 18.11     (b) The county agency must ensure that the funds are used 
 18.12  only to supplement and not supplant services available through 
 18.13  other public assistance or services programs. 
 18.14     (c) Unless specified in statute, the service standards for 
 18.15  alternative care services shall be the same as the service 
 18.16  standards defined in the elderly waiver.  Persons or agencies 
 18.17  must be employed by or under a contract with the county agency 
 18.18  or the public health nursing agency of the local board of health 
 18.19  in order to receive funding under the alternative care program. 
 18.20     (d) The adult foster care rate shall be considered a 
 18.21  difficulty of care payment and shall not include room and 
 18.22  board.  The adult foster care daily rate shall be negotiated 
 18.23  between the county agency and the foster care provider.  The 
 18.24  rate established under this section shall not exceed 75 percent 
 18.25  of the state average monthly nursing home payment for the case 
 18.26  mix classification to which the individual receiving foster care 
 18.27  is assigned, and it must allow for other alternative care 
 18.28  services to be authorized by the case manager. 
 18.29     (e) Personal care services may be provided by a personal 
 18.30  care provider organization.  A county agency may contract with a 
 18.31  relative of the client to provide personal care services, but 
 18.32  must ensure nursing supervision.  Covered personal care services 
 18.33  defined in section 256B.0627, subdivision 4, must meet 
 18.34  applicable standards in Minnesota Rules, part 9505.0335. 
 18.35     (f) A county may use alternative care funds to purchase 
 18.36  medical supplies and equipment without prior approval from the 
 19.1   commissioner when:  (1) there is no other funding source; (2) 
 19.2   the supplies and equipment are specified in the individual's 
 19.3   care plan as medically necessary to enable the individual to 
 19.4   remain in the community according to the criteria in Minnesota 
 19.5   Rules, part 9505.0210, item A; and (3) the supplies and 
 19.6   equipment represent an effective and appropriate use of 
 19.7   alternative care funds.  A county may use alternative care funds 
 19.8   to purchase supplies and equipment from a non-Medicaid certified 
 19.9   vendor if the cost for the items is less than that of a Medicaid 
 19.10  vendor.  A county is not required to contract with a provider of 
 19.11  supplies and equipment if the monthly cost of the supplies and 
 19.12  equipment is less than $250.  
 19.13     (g) For purposes of this section, residential care services 
 19.14  are services which are provided to individuals living in 
 19.15  residential care homes.  Residential care homes are currently 
 19.16  licensed as board and lodging establishments and are registered 
 19.17  with the department of health as providing special services.  
 19.18  Residential care services are defined as "supportive services" 
 19.19  and "health-related services."  "Supportive services" means the 
 19.20  provision of up to 24-hour supervision and oversight.  
 19.21  Supportive services includes:  (1) transportation, when provided 
 19.22  by the residential care center only; (2) socialization, when 
 19.23  socialization is part of the plan of care, has specific goals 
 19.24  and outcomes established, and is not diversional or recreational 
 19.25  in nature; (3) assisting clients in setting up meetings and 
 19.26  appointments; (4) assisting clients in setting up medical and 
 19.27  social services; (5) providing assistance with personal laundry, 
 19.28  such as carrying the client's laundry to the laundry room.  
 19.29  Assistance with personal laundry does not include any laundry, 
 19.30  such as bed linen, that is included in the room and board rate.  
 19.31  Health-related services are limited to minimal assistance with 
 19.32  dressing, grooming, and bathing and providing reminders to 
 19.33  residents to take medications that are self-administered or 
 19.34  providing storage for medications, if requested.  Individuals 
 19.35  receiving residential care services cannot receive both personal 
 19.36  care services and residential care services.  
 20.1      (h) For the purposes of this section, "assisted living" 
 20.2   refers to supportive services provided by a single vendor to 
 20.3   clients who reside in the same apartment building of three or 
 20.4   more units which are not subject to registration under chapter 
 20.5   144D.  Assisted living services are defined as up to 24-hour 
 20.6   supervision, and oversight, supportive services as defined in 
 20.7   clause (1), individualized home care aide tasks as defined in 
 20.8   clause (2), and individualized home management tasks as defined 
 20.9   in clause (3) provided to residents of a residential center 
 20.10  living in their units or apartments with a full kitchen and 
 20.11  bathroom.  A full kitchen includes a stove, oven, refrigerator, 
 20.12  food preparation counter space, and a kitchen utensil storage 
 20.13  compartment.  Assisted living services must be provided by the 
 20.14  management of the residential center or by providers under 
 20.15  contract with the management or with the county. 
 20.16     (1) Supportive services include:  
 20.17     (i) socialization, when socialization is part of the plan 
 20.18  of care, has specific goals and outcomes established, and is not 
 20.19  diversional or recreational in nature; 
 20.20     (ii) assisting clients in setting up meetings and 
 20.21  appointments; and 
 20.22     (iii) providing transportation, when provided by the 
 20.23  residential center only.  
 20.24     Individuals receiving assisted living services will not 
 20.25  receive both assisted living services and homemaking or personal 
 20.26  care services.  Individualized means services are chosen and 
 20.27  designed specifically for each resident's needs, rather than 
 20.28  provided or offered to all residents regardless of their 
 20.29  illnesses, disabilities, or physical conditions.  
 20.30     (2) Home care aide tasks means:  
 20.31     (i) preparing modified diets, such as diabetic or low 
 20.32  sodium diets; 
 20.33     (ii) reminding residents to take regularly scheduled 
 20.34  medications or to perform exercises; 
 20.35     (iii) household chores in the presence of technically 
 20.36  sophisticated medical equipment or episodes of acute illness or 
 21.1   infectious disease; 
 21.2      (iv) household chores when the resident's care requires the 
 21.3   prevention of exposure to infectious disease or containment of 
 21.4   infectious disease; and 
 21.5      (v) assisting with dressing, oral hygiene, hair care, 
 21.6   grooming, and bathing, if the resident is ambulatory, and if the 
 21.7   resident has no serious acute illness or infectious disease.  
 21.8   Oral hygiene means care of teeth, gums, and oral prosthetic 
 21.9   devices.  
 21.10     (3) Home management tasks means:  
 21.11     (i) housekeeping; 
 21.12     (ii) laundry; 
 21.13     (iii) preparation of regular snacks and meals; and 
 21.14     (iv) shopping.  
 21.15     Assisted living services as defined in this section shall 
 21.16  not be authorized in boarding and lodging establishments 
 21.17  licensed according to sections 157.011 and 157.15 to 157.22. 
 21.18     (i) For establishments registered under chapter 144D, 
 21.19  assisted living services under this section means the services 
 21.20  described and licensed under section 144A.4605. 
 21.21     (j) For the purposes of this section, reimbursement for 
 21.22  assisted living services and residential care services shall be 
 21.23  a monthly rate negotiated and authorized by the county 
 21.24  agency based on an individualized service plan for each resident.
 21.25  The rate shall not exceed the nonfederal share of the greater of 
 21.26  either the statewide or any of the geographic groups' weighted 
 21.27  average monthly medical assistance nursing facility payment rate 
 21.28  of the case mix resident class to which the 180-day eligible 
 21.29  client would be assigned under Minnesota Rules, parts 9549.0050 
 21.30  to 9549.0059.  For alternative care assisted living projects 
 21.31  established under Laws 1988, chapter 689, article 2, section 
 21.32  256, monthly rates may not exceed 65 percent of the greater of 
 21.33  either statewide or any of the geographic groups' weighted 
 21.34  average monthly medical assistance nursing facility payment rate 
 21.35  of the case mix resident class to which the 180-day eligible 
 21.36  client would be assigned under Minnesota Rules, parts 9549.0050 
 22.1   to 9549.0059.  The rate may not cover rent and direct food 
 22.2   costs, unless the services are provided by a home care provider 
 22.3   licensed by the department of health and are provided in a 
 22.4   building that is registered as a housing with services 
 22.5   establishment under chapter 144D and that provides 24-hour 
 22.6   supervision. 
 22.7      (j) (k) For purposes of this section, companion services 
 22.8   are defined as nonmedical care, supervision and oversight, 
 22.9   provided to a functionally impaired adult.  Companions may 
 22.10  assist the individual with such tasks as meal preparation, 
 22.11  laundry and shopping, but do not perform these activities as 
 22.12  discrete services.  The provision of companion services does not 
 22.13  entail hands-on medical care.  Providers may also perform light 
 22.14  housekeeping tasks which are incidental to the care and 
 22.15  supervision of the recipient.  This service must be approved by 
 22.16  the case manager as part of the care plan.  Companion services 
 22.17  must be provided by individuals or nonprofit organizations who 
 22.18  are under contract with the local agency to provide the 
 22.19  service.  Any person related to the waiver recipient by blood, 
 22.20  marriage or adoption cannot be reimbursed under this service.  
 22.21  Persons providing companion services will be monitored by the 
 22.22  case manager. 
 22.23     (k) (l) For purposes of this section, training for direct 
 22.24  informal caregivers is defined as a classroom or home course of 
 22.25  instruction which may include:  transfer and lifting skills, 
 22.26  nutrition, personal and physical cares, home safety in a home 
 22.27  environment, stress reduction and management, behavioral 
 22.28  management, long-term care decision making, care coordination 
 22.29  and family dynamics.  The training is provided to an informal 
 22.30  unpaid caregiver of a 180-day eligible client which enables the 
 22.31  caregiver to deliver care in a home setting with high levels of 
 22.32  quality.  The training must be approved by the case manager as 
 22.33  part of the individual care plan.  Individuals, agencies, and 
 22.34  educational facilities which provide caregiver training and 
 22.35  education will be monitored by the case manager. 
 22.36     Sec. 18.  Minnesota Statutes 1996, section 256B.0915, 
 23.1   subdivision 3, is amended to read: 
 23.2      Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 
 23.3   FORECASTING.] (a) The number of medical assistance waiver 
 23.4   recipients that a county may serve must be allocated according 
 23.5   to the number of medical assistance waiver cases open on July 1 
 23.6   of each fiscal year.  Additional recipients may be served with 
 23.7   the approval of the commissioner. 
 23.8      (b) The monthly limit for the cost of waivered services to 
 23.9   an individual waiver client shall be the statewide average 
 23.10  payment rate of the case mix resident class to which the waiver 
 23.11  client would be assigned under the medical assistance case mix 
 23.12  reimbursement system.  If medical supplies and equipment or 
 23.13  adaptations are or will be purchased for an elderly waiver 
 23.14  services recipient, the costs may be prorated on a monthly basis 
 23.15  throughout the year in which they are purchased.  If the monthly 
 23.16  cost of a recipient's other waivered services exceeds the 
 23.17  monthly limit established in this paragraph, the annual cost of 
 23.18  the waivered services shall be determined.  In this event, the 
 23.19  annual cost of waivered services shall not exceed 12 times the 
 23.20  monthly limit calculated in this paragraph.  The statewide 
 23.21  average payment rate is calculated by determining the statewide 
 23.22  average monthly nursing home rate, effective July 1 of the 
 23.23  fiscal year in which the cost is incurred, less the statewide 
 23.24  average monthly income of nursing home residents who are age 65 
 23.25  or older, and who are medical assistance recipients in the month 
 23.26  of March of the previous state fiscal year.  The annual cost 
 23.27  divided by 12 of elderly or disabled waivered services for a 
 23.28  person who is a nursing facility resident at the time of 
 23.29  requesting a determination of eligibility for elderly or 
 23.30  disabled waivered services shall not exceed the monthly payment 
 23.31  for the resident class assigned under Minnesota Rules, parts 
 23.32  9549.0050 to 9549.0059, for that resident in the nursing 
 23.33  facility where the resident currently resides.  The following 
 23.34  costs must be included in determining the total monthly costs 
 23.35  for the waiver client: 
 23.36     (1) cost of all waivered services, including extended 
 24.1   medical supplies and equipment; and 
 24.2      (2) cost of skilled nursing, home health aide, and personal 
 24.3   care services reimbursable by medical assistance.  
 24.4      (c) Medical assistance funding for skilled nursing 
 24.5   services, private duty nursing, home health aide, and personal 
 24.6   care services for waiver recipients must be approved by the case 
 24.7   manager and included in the individual care plan. 
 24.8      (d) For both the elderly waiver and the nursing facility 
 24.9   disabled waiver, a county may purchase extended supplies and 
 24.10  equipment without prior approval from the commissioner when 
 24.11  there is no other funding source and the supplies and equipment 
 24.12  are specified in the individual's care plan as medically 
 24.13  necessary to enable the individual to remain in the community 
 24.14  according to the criteria in Minnesota Rules, part 9505.0210, 
 24.15  items A and B.  A county is not required to contract with a 
 24.16  provider of supplies and equipment if the monthly cost of the 
 24.17  supplies and equipment is less than $250.  
 24.18     (e) For the fiscal year beginning on July 1, 1993, and for 
 24.19  subsequent fiscal years, the commissioner of human services 
 24.20  shall not provide automatic annual inflation adjustments for 
 24.21  home and community-based waivered services.  The commissioner of 
 24.22  finance shall include as a budget change request in each 
 24.23  biennial detailed expenditure budget submitted to the 
 24.24  legislature under section 16A.11, annual adjustments in 
 24.25  reimbursement rates for home and community-based waivered 
 24.26  services, based on the forecasted percentage change in the Home 
 24.27  Health Agency Market Basket of Operating Costs, for the fiscal 
 24.28  year beginning July 1, compared to the previous fiscal year, 
 24.29  unless otherwise adjusted by statute.  The Home Health Agency 
 24.30  Market Basket of Operating Costs is published by Data Resources, 
 24.31  Inc.  The forecast to be used is the one published for the 
 24.32  calendar quarter beginning January 1, six months prior to the 
 24.33  beginning of the fiscal year for which rates are set.  The adult 
 24.34  foster care rate shall be considered a difficulty of care 
 24.35  payment and shall not include room and board. 
 24.36     (f) The adult foster care daily rate for the elderly and 
 25.1   disabled waivers shall be negotiated between the county agency 
 25.2   and the foster care provider.  The rate established under this 
 25.3   section shall not exceed the state average monthly nursing home 
 25.4   payment for the case mix classification to which the individual 
 25.5   receiving foster care is assigned; the rate must allow for other 
 25.6   waiver and medical assistance home care services to be 
 25.7   authorized by the case manager. 
 25.8      (g) The assisted living and residential care service rates 
 25.9   for elderly and community alternatives for disabled individuals 
 25.10  (CADI) waivers shall be made to the vendor as a monthly rate 
 25.11  negotiated with the county agency based on an individualized 
 25.12  service plan for each resident.  The rate shall not exceed the 
 25.13  nonfederal share of the greater of either the statewide or any 
 25.14  of the geographic groups' weighted average monthly medical 
 25.15  assistance nursing facility payment rate of the case mix 
 25.16  resident class to which the elderly or disabled client would be 
 25.17  assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, 
 25.18  unless the services are provided by a home care provider 
 25.19  licensed by the department of health and are provided in a 
 25.20  building that is registered as a housing with services 
 25.21  establishment under chapter 144D and that provides 24-hour 
 25.22  supervision.  For alternative care assisted living projects 
 25.23  established under Laws 1988, chapter 689, article 2, section 
 25.24  256, monthly rates may not exceed 65 percent of the greater of 
 25.25  either the statewide or any of the geographic groups' weighted 
 25.26  average monthly medical assistance nursing facility payment rate 
 25.27  for the case mix resident class to which the elderly or disabled 
 25.28  client would be assigned under Minnesota Rules, parts 9549.0050 
 25.29  to 9549.0059.  The rate may not cover direct rent or food costs. 
 25.30     (h) The county shall negotiate individual rates with 
 25.31  vendors and may be reimbursed for actual costs up to the greater 
 25.32  of the county's current approved rate or 60 percent of the 
 25.33  maximum rate in fiscal year 1994 and 65 percent of the maximum 
 25.34  rate in fiscal year 1995 for each service within each program. 
 25.35     (i) On July 1, 1993, the commissioner shall increase the 
 25.36  maximum rate for home-delivered meals to $4.50 per meal. 
 26.1      (j) Reimbursement for the medical assistance recipients 
 26.2   under the approved waiver shall be made from the medical 
 26.3   assistance account through the invoice processing procedures of 
 26.4   the department's Medicaid Management Information System (MMIS), 
 26.5   only with the approval of the client's case manager.  The budget 
 26.6   for the state share of the Medicaid expenditures shall be 
 26.7   forecasted with the medical assistance budget, and shall be 
 26.8   consistent with the approved waiver.  
 26.9      (k) Beginning July 1, 1991, the state shall reimburse 
 26.10  counties according to the payment schedule in section 256.025 
 26.11  for the county share of costs incurred under this subdivision on 
 26.12  or after January 1, 1991, for individuals who are receiving 
 26.13  medical assistance. 
 26.14     Sec. 19.  Minnesota Statutes 1996, section 256I.04, 
 26.15  subdivision 2a, is amended to read: 
 26.16     Subd. 2a.  [LICENSE REQUIRED.] A county agency may not 
 26.17  enter into an agreement with an establishment to provide group 
 26.18  residential housing unless:  
 26.19     (1) the establishment is licensed by the department of 
 26.20  health as a hotel and restaurant; a board and lodging 
 26.21  establishment; a residential care home; a boarding care home 
 26.22  before March 1, 1985; or a supervised living facility, and the 
 26.23  service provider for residents of the facility is licensed under 
 26.24  chapter 245A.  However, an establishment licensed by the 
 26.25  department of health to provide lodging need not also be 
 26.26  licensed to provide board if meals are being supplied to 
 26.27  residents under a contract with a food vendor who is licensed by 
 26.28  the department of health; or 
 26.29     (2) the residence is licensed by the commissioner of human 
 26.30  services under Minnesota Rules, parts 9555.5050 to 9555.6265, or 
 26.31  certified by a county human services agency prior to July 1, 
 26.32  1992, using the standards under Minnesota Rules, parts 9555.5050 
 26.33  to 9555.6265; or 
 26.34     (3) the establishment is registered under chapter 144D and 
 26.35  provides three meals a day. 
 26.36     The requirements under clauses (1) and, (2), and (3) do not 
 27.1   apply to establishments exempt from state licensure because they 
 27.2   are located on Indian reservations and subject to tribal health 
 27.3   and safety requirements. 
 27.4      Sec. 20.  Minnesota Statutes 1996, section 462.357, 
 27.5   subdivision 7, is amended to read: 
 27.6      Subd. 7.  [PERMITTED SINGLE FAMILY USE.] A state licensed 
 27.7   residential facility or a housing with services establishment 
 27.8   registered under chapter 144D serving six or fewer persons, a 
 27.9   licensed day care facility serving 12 or fewer persons, and a 
 27.10  group family day care facility licensed under Minnesota Rules, 
 27.11  parts 9502.0315 to 9502.0445 to serve 14 or fewer children shall 
 27.12  be considered a permitted single family residential use of 
 27.13  property for the purposes of zoning, except that a residential 
 27.14  facility whose primary purpose is to treat juveniles who have 
 27.15  violated criminal statutes relating to sex offenses or have been 
 27.16  adjudicated delinquent on the basis of conduct in violation of 
 27.17  criminal statutes relating to sex offenses shall not be 
 27.18  considered a permitted use. 
 27.19     Sec. 21.  [STUDY OF NURSING HOME PROVISION OF HOME CARE 
 27.20  SERVICES.] 
 27.21     The commissioner of health shall perform a study to 
 27.22  determine the most appropriate and cost-effective way to enable 
 27.23  licensing nursing home and boarding care home providers to use 
 27.24  their existing pool of trained staff to provide home care 
 27.25  services in a housing with services establishment registered 
 27.26  according to Minnesota Statutes, chapter 144D, that is attached 
 27.27  to or located on property contiguous to the nursing home or 
 27.28  boarding care home.  The study shall evaluate comparability of 
 27.29  current home care licensing, enforcement, and quality assurance 
 27.30  provisions with alternative regulatory structures, including but 
 27.31  not limited to private contracts, home care license options, and 
 27.32  nursing home license options.  The commissioner shall convene an 
 27.33  advisory group that is representative of the affected parties to 
 27.34  advise the department of the feasibility of proposed options.  
 27.35  The commissioner shall submit a report to the chairs of the 
 27.36  senate health and family security committee and the house of 
 28.1   representatives health and human services committee no later 
 28.2   than January 15, 1998. 
 28.3      Sec. 22.  [REPEALER.] 
 28.4      Minnesota Statutes 1996, sections 144A.45, subdivision 3; 
 28.5   144A.49; 144B.01; 144B.02; 144B.03; 144B.04; 144B.05; 144B.06; 
 28.6   144B.07; 144B.08; 144B.09; 144B.10; 144B.11; 144B.12; 144B.13; 
 28.7   144B.14; 144B.15; 144B.16; and 144B.17, are repealed.