1.1                          A bill for an act 
  1.2             relating to human services; changing provisions to 
  1.3             improve access to home and community-based options for 
  1.4             individuals with disabilities; modifying provisions 
  1.5             for consumer control in some services; creating a 
  1.6             consumer-directed home care demonstration project; 
  1.7             amending Minnesota Statutes 2000, sections 245A.13, 
  1.8             subdivision 7, 8; 252.275, subdivision 4b; 254B.03, 
  1.9             subdivision 1; 254B.09, by adding a subdivision; 
  1.10            256.01, by adding a subdivision; 256.476, subdivisions 
  1.11            1, 2, 3, 4, 5, 8; 256B.0625, subdivisions 7, 19a, 19c, 
  1.12            20, by adding a subdivision; 256B.0627, subdivisions 
  1.13            1, 2, 4, 5, 7, 8, 10, 11, by adding subdivisions; 
  1.14            256B.0911, by adding a subdivision; 256B.093, 
  1.15            subdivision 3; 256B.095; 256B.0951, subdivisions 1, 3, 
  1.16            4, 5, 6, 7, by adding a subdivision; 256B.0952, 
  1.17            subdivisions 1, 4; 256B.0955; 256B.49, by adding 
  1.18            subdivisions; 256B.5012, by adding a subdivision; 
  1.19            256D.35, by adding subdivisions; 256D.44, subdivision 
  1.20            5. 
  1.21  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.22     Section 1.  Minnesota Statutes 2000, section 245A.13, 
  1.23  subdivision 7, is amended to read: 
  1.24     Subd. 7.  [RATE RECOMMENDATION.] The commissioner of human 
  1.25  services may review rates of a residential program participating 
  1.26  in the medical assistance program which is in receivership and 
  1.27  that has needs or deficiencies documented by the department of 
  1.28  health or the department of human services.  If the commissioner 
  1.29  of human services determines that a review of the rate 
  1.30  established under section 256B.501 sections 256B.5012 and 
  1.31  256B.5013 is needed, the commissioner shall: 
  1.32     (1) review the order or determination that cites the 
  1.33  deficiencies or needs; and 
  2.1      (2) determine the need for additional staff, additional 
  2.2   annual hours by type of employee, and additional consultants, 
  2.3   services, supplies, equipment, repairs, or capital assets 
  2.4   necessary to satisfy the needs or deficiencies. 
  2.5      Sec. 2.  Minnesota Statutes 2000, section 245A.13, 
  2.6   subdivision 8, is amended to read: 
  2.7      Subd. 8.  [ADJUSTMENT TO THE RATE.] Upon review of rates 
  2.8   under subdivision 7, the commissioner may adjust the residential 
  2.9   program's payment rate.  The commissioner shall review the 
  2.10  circumstances, together with the residential program cost report 
  2.11  program's most recent income and expense report, to determine 
  2.12  whether or not the deficiencies or needs can be corrected or met 
  2.13  by reallocating residential program staff, costs, revenues, 
  2.14  or any other resources including any investments, efficiency 
  2.15  incentives, or allowances.  If the commissioner determines that 
  2.16  any deficiency cannot be corrected or the need cannot be met 
  2.17  with the payment rate currently being paid, the commissioner 
  2.18  shall determine the payment rate adjustment by dividing the 
  2.19  additional annual costs established during the commissioner's 
  2.20  review by the residential program's actual resident days from 
  2.21  the most recent desk-audited cost income and expense report or 
  2.22  the estimated resident days in the projected receivership 
  2.23  period.  The payment rate adjustment must meet the conditions in 
  2.24  Minnesota Rules, parts 9553.0010 to 9553.0080, and remains in 
  2.25  effect during the period of the receivership or until another 
  2.26  date set by the commissioner.  Upon the subsequent sale, 
  2.27  closure, or transfer of the residential program, the 
  2.28  commissioner may recover amounts that were paid as payment rate 
  2.29  adjustments under this subdivision.  This recovery shall be 
  2.30  determined through a review of actual costs and resident days in 
  2.31  the receivership period.  The costs the commissioner finds to be 
  2.32  allowable shall be divided by the actual resident days for the 
  2.33  receivership period.  This rate shall be compared to the rate 
  2.34  paid throughout the receivership period, with the difference, 
  2.35  multiplied by resident days, being the amount to be repaid to 
  2.36  the commissioner.  Allowable costs shall be determined by the 
  3.1   commissioner as those ordinary, necessary, and related to 
  3.2   resident care by prudent and cost-conscious management.  The 
  3.3   buyer or transferee shall repay this amount to the commissioner 
  3.4   within 60 days after the commissioner notifies the buyer or 
  3.5   transferee of the obligation to repay.  This provision does not 
  3.6   limit the liability of the seller to the commissioner pursuant 
  3.7   to section 256B.0641. 
  3.8      Sec. 3.  Minnesota Statutes 2000, section 252.275, 
  3.9   subdivision 4b, is amended to read: 
  3.10     Subd. 4b.  [GUARANTEED FLOOR.] Each county with an original 
  3.11  allocation for the preceding year that is equal to or less than 
  3.12  the guaranteed floor minimum index shall have a guaranteed floor 
  3.13  equal to its original allocation for the preceding year.  Each 
  3.14  county with an original allocation for the preceding year that 
  3.15  is greater than the guaranteed floor minimum index shall have a 
  3.16  guaranteed floor equal to the lesser of clause (1) or (2): 
  3.17     (1) the county's original allocation for the preceding 
  3.18  year; or 
  3.19     (2) 70 percent of the county's reported expenditures 
  3.20  eligible for reimbursement during the 12 months ending on June 
  3.21  30 of the preceding calendar year. 
  3.22     For calendar year 1993, the guaranteed floor minimum index 
  3.23  shall be $20,000.  For each subsequent year, the index shall be 
  3.24  adjusted by the projected change in the average value in the 
  3.25  United States Department of Labor Bureau of Labor Statistics 
  3.26  consumer price index (all urban) for that year. 
  3.27     Notwithstanding this subdivision, no county shall be 
  3.28  allocated a guaranteed floor of less than $1,000. 
  3.29     When the amount of funds available for allocation is less 
  3.30  than the amount available in the previous year, each county's 
  3.31  previous year allocation shall be reduced in proportion to the 
  3.32  reduction in the statewide funding, to establish each county's 
  3.33  guaranteed floor. 
  3.34     Sec. 4.  Minnesota Statutes 2000, section 254B.03, 
  3.35  subdivision 1, is amended to read: 
  3.36     Subdivision 1.  [LOCAL AGENCY DUTIES.] (a) Every local 
  4.1   agency shall provide chemical dependency services to persons 
  4.2   residing within its jurisdiction who meet criteria established 
  4.3   by the commissioner for placement in a chemical dependency 
  4.4   residential or nonresidential treatment service.  Chemical 
  4.5   dependency money must be administered by the local agencies 
  4.6   according to law and rules adopted by the commissioner under 
  4.7   sections 14.001 to 14.69. 
  4.8      (b) In order to contain costs, the county board shall, with 
  4.9   the approval of the commissioner of human services, select 
  4.10  eligible vendors of chemical dependency services who can provide 
  4.11  economical and appropriate treatment.  Unless the local agency 
  4.12  is a social services department directly administered by a 
  4.13  county or human services board, the local agency shall not be an 
  4.14  eligible vendor under section 254B.05.  The commissioner may 
  4.15  approve proposals from county boards to provide services in an 
  4.16  economical manner or to control utilization, with safeguards to 
  4.17  ensure that necessary services are provided.  If a county 
  4.18  implements a demonstration or experimental medical services 
  4.19  funding plan, the commissioner shall transfer the money as 
  4.20  appropriate.  If a county selects a vendor located in another 
  4.21  state, the county shall ensure that the vendor is in compliance 
  4.22  with the rules governing licensure of programs located in the 
  4.23  state. 
  4.24     (c) The calendar year 1998 2002 rate for vendors may not 
  4.25  increase more than three two percent above the rate approved in 
  4.26  effect on January 1, 1997 2001.  The calendar year 1999 2003 
  4.27  rate for vendors may not increase more than three two percent 
  4.28  above the rate in effect on January 1, 1998 2002. 
  4.29     (d) A culturally specific vendor that provides assessments 
  4.30  under a variance under Minnesota Rules, part 9530.6610, shall be 
  4.31  allowed to provide assessment services to persons not covered by 
  4.32  the variance. 
  4.33     Sec. 5.  Minnesota Statutes 2000, section 254B.09, is 
  4.34  amended by adding a subdivision to read: 
  4.35     Subd. 8.  [PAYMENTS TO IMPROVE SERVICES TO AMERICAN 
  4.36  INDIANS.] The commissioner may set rates for chemical dependency 
  5.1   services according to the American Indian Health Improvement 
  5.2   Act, Public Law Number 94-437, for eligible vendors.  These 
  5.3   rates shall supersede rates set in county purchase of service 
  5.4   agreements when payments are made on behalf of clients eligible 
  5.5   according to Public Law Number 94-437. 
  5.6      Sec. 6.  Minnesota Statutes 2000, section 256.01, is 
  5.7   amended by adding a subdivision to read: 
  5.8      Subd. 19.  [GRANTS FOR CASE MANAGEMENT SERVICES TO PERSONS 
  5.9   WITH HIV OR AIDS.] The commissioner may award grants to eligible 
  5.10  vendors for the development, implementation, and evaluation of 
  5.11  case management services for individuals infected with the human 
  5.12  immunodeficiency virus.  HIV/AIDs case management services will 
  5.13  be provided to increase access to cost effective health care 
  5.14  services, to reduce the risk of HIV transmission, to ensure that 
  5.15  basic client needs are met, and to increase client access to 
  5.16  needed community supports or services. 
  5.17     Sec. 7.  Minnesota Statutes 2000, section 256.476, 
  5.18  subdivision 1, is amended to read: 
  5.19     Subdivision 1.  [PURPOSE AND GOALS.] The commissioner of 
  5.20  human services shall establish a consumer support grant 
  5.21  program to assist for individuals with functional limitations 
  5.22  and their families in purchasing and securing supports which the 
  5.23  individuals need to live as independently and productively in 
  5.24  the community as possible who wish to purchase and secure their 
  5.25  own supports.  The commissioner and local agencies shall jointly 
  5.26  develop an implementation plan which must include a way to 
  5.27  resolve the issues related to county liability.  The program 
  5.28  shall: 
  5.29     (1) make support grants available to individuals or 
  5.30  families as an effective alternative to existing programs and 
  5.31  services, such as the developmental disability family support 
  5.32  program, the alternative care program, personal care attendant 
  5.33  services, home health aide services, and private duty nursing 
  5.34  facility services; 
  5.35     (2) provide consumers more control, flexibility, and 
  5.36  responsibility over the needed supports their services and 
  6.1   supports; 
  6.2      (3) promote local program management and decision making; 
  6.3   and 
  6.4      (4) encourage the use of informal and typical community 
  6.5   supports. 
  6.6      Sec. 8.  Minnesota Statutes 2000, section 256.476, 
  6.7   subdivision 2, is amended to read: 
  6.8      Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  6.9   following terms have the meanings given them: 
  6.10     (a) "County board" means the county board of commissioners 
  6.11  for the county of financial responsibility as defined in section 
  6.12  256G.02, subdivision 4, or its designated representative.  When 
  6.13  a human services board has been established under sections 
  6.14  402.01 to 402.10, it shall be considered the county board for 
  6.15  the purposes of this section. 
  6.16     (b) "Family" means the person's birth parents, adoptive 
  6.17  parents or stepparents, siblings or stepsiblings, children or 
  6.18  stepchildren, grandparents, grandchildren, niece, nephew, aunt, 
  6.19  uncle, or spouse.  For the purposes of this section, a family 
  6.20  member is at least 18 years of age. 
  6.21     (c) "Functional limitations" means the long-term inability 
  6.22  to perform an activity or task in one or more areas of major 
  6.23  life activity, including self-care, understanding and use of 
  6.24  language, learning, mobility, self-direction, and capacity for 
  6.25  independent living.  For the purpose of this section, the 
  6.26  inability to perform an activity or task results from a mental, 
  6.27  emotional, psychological, sensory, or physical disability, 
  6.28  condition, or illness. 
  6.29     (d) "Informed choice" means a voluntary decision made by 
  6.30  the person or the person's legal representative, after becoming 
  6.31  familiarized with the alternatives to: 
  6.32     (1) select a preferred alternative from a number of 
  6.33  feasible alternatives; 
  6.34     (2) select an alternative which may be developed in the 
  6.35  future; and 
  6.36     (3) refuse any or all alternatives. 
  7.1      (e) "Local agency" means the local agency authorized by the 
  7.2   county board to carry out the provisions of this section. 
  7.3      (f) "Person" or "persons" means a person or persons meeting 
  7.4   the eligibility criteria in subdivision 3. 
  7.5      (g) "Authorized representative" means an individual 
  7.6   designated by the person or their legal representative to act on 
  7.7   their behalf.  This individual may be a family member, guardian, 
  7.8   representative payee, or other individual designated by the 
  7.9   person or their legal representative, if any, to assist in 
  7.10  purchasing and arranging for supports.  For the purposes of this 
  7.11  section, an authorized representative is at least 18 years of 
  7.12  age. 
  7.13     (h) "Screening" means the screening of a person's service 
  7.14  needs under sections 256B.0911 and 256B.092. 
  7.15     (i) "Supports" means services, care, aids, home 
  7.16  environmental modifications, or assistance purchased by the 
  7.17  person or the person's family.  Examples of supports include 
  7.18  respite care, assistance with daily living, and adaptive aids 
  7.19  assistive technology.  For the purpose of this section, 
  7.20  notwithstanding the provisions of section 144A.43, supports 
  7.21  purchased under the consumer support program are not considered 
  7.22  home care services. 
  7.23     (j) "Program of origination" means the program the 
  7.24  individual transferred from when approved for the consumer 
  7.25  support grant program. 
  7.26     Sec. 9.  Minnesota Statutes 2000, section 256.476, 
  7.27  subdivision 3, is amended to read: 
  7.28     Subd. 3.  [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person 
  7.29  is eligible to apply for a consumer support grant if the person 
  7.30  meets all of the following criteria: 
  7.31     (1) the person is eligible for and has been approved to 
  7.32  receive services under medical assistance as determined under 
  7.33  sections 256B.055 and 256B.056 or the person is eligible for and 
  7.34  has been approved to receive services under alternative care 
  7.35  services as determined under section 256B.0913 or the person has 
  7.36  been approved to receive a grant under the developmental 
  8.1   disability family support program under section 252.32; 
  8.2      (2) the person is able to direct and purchase the person's 
  8.3   own care and supports, or the person has a family member, legal 
  8.4   representative, or other authorized representative who can 
  8.5   purchase and arrange supports on the person's behalf; 
  8.6      (3) the person has functional limitations, requires ongoing 
  8.7   supports to live in the community, and is at risk of or would 
  8.8   continue institutionalization without such supports; and 
  8.9      (4) the person will live in a home.  For the purpose of 
  8.10  this section, "home" means the person's own home or home of a 
  8.11  person's family member.  These homes are natural home settings 
  8.12  and are not licensed by the department of health or human 
  8.13  services. 
  8.14     (b) Persons may not concurrently receive a consumer support 
  8.15  grant if they are: 
  8.16     (1) receiving home and community-based services under 
  8.17  United States Code, title 42, section 1396h(c); personal care 
  8.18  attendant and home health aide services under section 256B.0625; 
  8.19  a developmental disability family support grant; or alternative 
  8.20  care services under section 256B.0913; or 
  8.21     (2) residing in an institutional or congregate care setting.
  8.22     (c) A person or person's family receiving a consumer 
  8.23  support grant shall not be charged a fee or premium by a local 
  8.24  agency for participating in the program.  
  8.25     (d) The commissioner may limit the participation of nursing 
  8.26  facility residents, residents of intermediate care facilities 
  8.27  for persons with mental retardation, and the recipients of 
  8.28  services from federal waiver programs in the consumer support 
  8.29  grant program if the participation of these individuals will 
  8.30  result in an increase in the cost to the state. 
  8.31     (e) The commissioner shall establish a budgeted 
  8.32  appropriation each fiscal year for the consumer support grant 
  8.33  program.  The number of individuals participating in the program 
  8.34  will be adjusted so the total amount allocated to counties does 
  8.35  not exceed the amount of the budgeted appropriation.  The 
  8.36  budgeted appropriation will be adjusted annually to accommodate 
  9.1   changes in demand for the consumer support grants. 
  9.2      Sec. 10.  Minnesota Statutes 2000, section 256.476, 
  9.3   subdivision 4, is amended to read: 
  9.4      Subd. 4.  [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 
  9.5   county board may choose to participate in the consumer support 
  9.6   grant program.  If a county board chooses to participate in the 
  9.7   program, the local agency shall establish written procedures and 
  9.8   criteria to determine the amount and use of support grants.  
  9.9   These procedures must include, at least, the availability of 
  9.10  respite care, assistance with daily living, and adaptive aids.  
  9.11  The local agency may establish monthly or annual maximum amounts 
  9.12  for grants and procedures where exceptional resources may be 
  9.13  required to meet the health and safety needs of the person on a 
  9.14  time-limited basis, however, the total amount awarded to each 
  9.15  individual may not exceed the limits established in subdivision 
  9.16  5, paragraph (f). 
  9.17     (b) Support grants to a person or a person's family will be 
  9.18  provided through a monthly subsidy payment and be in the form of 
  9.19  cash, voucher, or direct county payment to vendor.  Support 
  9.20  grant amounts must be determined by the local agency.  Each 
  9.21  service and item purchased with a support grant must meet all of 
  9.22  the following criteria:  
  9.23     (1) it must be over and above the normal cost of caring for 
  9.24  the person if the person did not have functional limitations; 
  9.25     (2) it must be directly attributable to the person's 
  9.26  functional limitations; 
  9.27     (3) it must enable the person or the person's family to 
  9.28  delay or prevent out-of-home placement of the person; and 
  9.29     (4) it must be consistent with the needs identified in the 
  9.30  service plan, when applicable. 
  9.31     (c) Items and services purchased with support grants must 
  9.32  be those for which there are no other public or private funds 
  9.33  available to the person or the person's family.  Fees assessed 
  9.34  to the person or the person's family for health and human 
  9.35  services are not reimbursable through the grant. 
  9.36     (d) In approving or denying applications, the local agency 
 10.1   shall consider the following factors:  
 10.2      (1) the extent and areas of the person's functional 
 10.3   limitations; 
 10.4      (2) the degree of need in the home environment for 
 10.5   additional support; and 
 10.6      (3) the potential effectiveness of the grant to maintain 
 10.7   and support the person in the family environment or the person's 
 10.8   own home. 
 10.9      (e) At the time of application to the program or screening 
 10.10  for other services, the person or the person's family shall be 
 10.11  provided sufficient information to ensure an informed choice of 
 10.12  alternatives by the person, the person's legal representative, 
 10.13  if any, or the person's family.  The application shall be made 
 10.14  to the local agency and shall specify the needs of the person 
 10.15  and family, the form and amount of grant requested, the items 
 10.16  and services to be reimbursed, and evidence of eligibility for 
 10.17  medical assistance or alternative care program. 
 10.18     (f) Upon approval of an application by the local agency and 
 10.19  agreement on a support plan for the person or person's family, 
 10.20  the local agency shall make grants to the person or the person's 
 10.21  family.  The grant shall be in an amount for the direct costs of 
 10.22  the services or supports outlined in the service agreement.  
 10.23     (g) Reimbursable costs shall not include costs for 
 10.24  resources already available, such as special education classes, 
 10.25  day training and habilitation, case management, other services 
 10.26  to which the person is entitled, medical costs covered by 
 10.27  insurance or other health programs, or other resources usually 
 10.28  available at no cost to the person or the person's family. 
 10.29     (h) The state of Minnesota, the county boards participating 
 10.30  in the consumer support grant program, or the agencies acting on 
 10.31  behalf of the county boards in the implementation and 
 10.32  administration of the consumer support grant program shall not 
 10.33  be liable for damages, injuries, or liabilities sustained 
 10.34  through the purchase of support by the individual, the 
 10.35  individual's family, or the authorized representative under this 
 10.36  section with funds received through the consumer support grant 
 11.1   program.  Liabilities include but are not limited to:  workers' 
 11.2   compensation liability, the Federal Insurance Contributions Act 
 11.3   (FICA), or the Federal Unemployment Tax Act (FUTA).  For 
 11.4   purposes of this section, participating county boards and 
 11.5   agencies acting on behalf of county boards are exempt from the 
 11.6   provisions of section 268.04. 
 11.7      Sec. 11.  Minnesota Statutes 2000, section 256.476, 
 11.8   subdivision 5, is amended to read: 
 11.9      Subd. 5.  [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 
 11.10  For the purpose of transferring persons to the consumer support 
 11.11  grant program from specific programs or services, such as the 
 11.12  developmental disability family support program and alternative 
 11.13  care program, personal care attendant services, home health aide 
 11.14  services, or nursing facility private duty nursing services, the 
 11.15  amount of funds transferred by the commissioner between the 
 11.16  developmental disability family support program account, the 
 11.17  alternative care account, the medical assistance account, or the 
 11.18  consumer support grant account shall be based on each county's 
 11.19  participation in transferring persons to the consumer support 
 11.20  grant program from those programs and services. 
 11.21     (b) At the beginning of each fiscal year, county 
 11.22  allocations for consumer support grants shall be based on: 
 11.23     (1) the number of persons to whom the county board expects 
 11.24  to provide consumer supports grants; 
 11.25     (2) their eligibility for current program and services; 
 11.26     (3) the amount of nonfederal dollars expended on those 
 11.27  individuals for those programs and services or, in situations 
 11.28  where an individual is unable to obtain the support needed from 
 11.29  the program of origination due to the unavailability of service 
 11.30  providers at the time or the location where the supports are 
 11.31  needed, the allocation will be based on the county's best 
 11.32  estimate of the nonfederal dollars that would have been expended 
 11.33  if the services had been available; and 
 11.34     (4) projected dates when persons will start receiving 
 11.35  grants.  County allocations shall be adjusted periodically by 
 11.36  the commissioner based on the actual transfer of persons or 
 12.1   service openings, and the nonfederal dollars associated with 
 12.2   those persons or service openings, to the consumer support grant 
 12.3   program. 
 12.4      (c) The amount of funds transferred by the commissioner 
 12.5   from the alternative care account and the medical assistance 
 12.6   account for an individual may be changed if it is determined by 
 12.7   the county or its agent that the individual's need for support 
 12.8   has changed. 
 12.9      (d) The authority to utilize funds transferred to the 
 12.10  consumer support grant account for the purposes of implementing 
 12.11  and administering the consumer support grant program will not be 
 12.12  limited or constrained by the spending authority provided to the 
 12.13  program of origination. 
 12.14     (e) The commissioner shall use up to five percent of each 
 12.15  county's allocation, as adjusted, for payments to that county 
 12.16  for administrative expenses, to be paid as a proportionate 
 12.17  addition to reported direct service expenditures. 
 12.18     (f) Except as provided in this paragraph, the county 
 12.19  allocation for each individual or individual's family cannot 
 12.20  exceed 80 percent of the total nonfederal dollars expended on 
 12.21  the individual by the program of origination except for the 
 12.22  developmental disabilities family support grant program which 
 12.23  can be approved up to 100 percent of the nonfederal dollars and 
 12.24  in situations as described in paragraph (b), clause (3).  In 
 12.25  situations where exceptional need exists or the individual's 
 12.26  need for support increases, up to 100 percent of the nonfederal 
 12.27  dollars expended by the consumer's program of origination may be 
 12.28  allocated to the county.  Allocations that exceed 80 percent of 
 12.29  the nonfederal dollars expended on the individual by the program 
 12.30  of origination must be approved by the commissioner.  The 
 12.31  remainder of the amount expended on the individual by the 
 12.32  program of origination will be used in the following 
 12.33  proportions:  half will be made available to the consumer 
 12.34  support grant program and participating counties for consumer 
 12.35  training, resource development, and other costs, and half will 
 12.36  be returned to the state general fund. 
 13.1      (g) The commissioner may recover, suspend, or withhold 
 13.2   payments if the county board, local agency, or grantee does not 
 13.3   comply with the requirements of this section. 
 13.4      Sec. 12.  Minnesota Statutes 2000, section 256.476, 
 13.5   subdivision 8, is amended to read: 
 13.6      Subd. 8.  [COMMISSIONER RESPONSIBILITIES.] The commissioner 
 13.7   shall: 
 13.8      (1) transfer and allocate funds pursuant to this section; 
 13.9      (2) determine allocations based on projected and actual 
 13.10  local agency use; 
 13.11     (3) monitor and oversee overall program spending; 
 13.12     (4) evaluate the effectiveness of the program; 
 13.13     (5) provide training and technical assistance for local 
 13.14  agencies and consumers to help identify potential applicants to 
 13.15  the program; and 
 13.16     (6) develop guidelines for local agency program 
 13.17  administration and consumer information; and.  
 13.18     (7) apply for a federal waiver or take any other action 
 13.19  necessary to maximize federal funding for the program by 
 13.20  September 1, 1999. 
 13.21     Sec. 13.  Minnesota Statutes 2000, section 256B.0625, 
 13.22  subdivision 7, is amended to read: 
 13.23     Subd. 7.  [PRIVATE DUTY NURSING.] Medical assistance covers 
 13.24  private duty nursing services in a recipient's home.  Recipients 
 13.25  who are authorized to receive private duty nursing services in 
 13.26  their home may use approved hours outside of the home during 
 13.27  hours when normal life activities take them outside of their 
 13.28  home and when, without the provision of private duty nursing, 
 13.29  their health and safety would be jeopardized.  To use private 
 13.30  duty nursing services at school, the recipient or responsible 
 13.31  party must provide written authorization in the care plan 
 13.32  identifying the chosen provider and the daily amount of services 
 13.33  to be used at school.  Medical assistance does not cover private 
 13.34  duty nursing services for residents of a hospital, nursing 
 13.35  facility, intermediate care facility, or a health care facility 
 13.36  licensed by the commissioner of health, except as authorized in 
 14.1   section 256B.64 for ventilator-dependent recipients in hospitals 
 14.2   or unless a resident who is otherwise eligible is on leave from 
 14.3   the facility and the facility either pays for the private duty 
 14.4   nursing services or forgoes the facility per diem for the leave 
 14.5   days that private duty nursing services are used.  Total hours 
 14.6   of service and payment allowed for services outside the home 
 14.7   cannot exceed that which is otherwise allowed in an in-home 
 14.8   setting according to section 256B.0627.  All private duty 
 14.9   nursing services must be provided according to the limits 
 14.10  established under section 256B.0627.  Private duty nursing 
 14.11  services may not be reimbursed if the nurse is the spouse of the 
 14.12  recipient or the parent or foster care provider of a recipient 
 14.13  who is under age 18, or the recipient's legal guardian. 
 14.14     Sec. 14.  Minnesota Statutes 2000, section 256B.0625, 
 14.15  subdivision 19a, is amended to read: 
 14.16     Subd. 19a.  [PERSONAL CARE SERVICES.] Medical assistance 
 14.17  covers personal care services in a recipient's home.  To qualify 
 14.18  for personal care services, recipients or responsible parties 
 14.19  must be able to identify the recipient's needs, direct and 
 14.20  evaluate task accomplishment, and provide for health and 
 14.21  safety.  Approved hours may be used outside the home when normal 
 14.22  life activities take them outside the home and when, without the 
 14.23  provision of personal care, their health and safety would be 
 14.24  jeopardized.  To use personal care services at school, the 
 14.25  recipient or responsible party must provide written 
 14.26  authorization in the care plan identifying the chosen provider 
 14.27  and the daily amount of services to be used at school.  Total 
 14.28  hours for services, whether actually performed inside or outside 
 14.29  the recipient's home, cannot exceed that which is otherwise 
 14.30  allowed for personal care services in an in-home setting 
 14.31  according to section 256B.0627.  Medical assistance does not 
 14.32  cover personal care services for residents of a hospital, 
 14.33  nursing facility, intermediate care facility, health care 
 14.34  facility licensed by the commissioner of health, or unless a 
 14.35  resident who is otherwise eligible is on leave from the facility 
 14.36  and the facility either pays for the personal care services or 
 15.1   forgoes the facility per diem for the leave days that personal 
 15.2   care services are used.  All personal care services must be 
 15.3   provided according to section 256B.0627.  Personal care services 
 15.4   may not be reimbursed if the personal care assistant is the 
 15.5   spouse or legal guardian of the recipient or the parent of a 
 15.6   recipient under age 18, or the responsible party or the foster 
 15.7   care provider of a recipient who cannot direct the recipient's 
 15.8   own care unless, in the case of a foster care provider, a county 
 15.9   or state case manager visits the recipient as needed, but not 
 15.10  less than every six months, to monitor the health and safety of 
 15.11  the recipient and to ensure the goals of the care plan are met.  
 15.12  Parents of adult recipients, adult children of the recipient or 
 15.13  adult siblings of the recipient may be reimbursed for personal 
 15.14  care services if they are not the recipient's legal guardian 
 15.15  and, if they are granted a waiver under section 256B.0627.  
 15.16  Until July 1, 2001, and Notwithstanding the provisions of 
 15.17  section 256B.0627, subdivision 4, paragraph (b), clause (4), the 
 15.18  noncorporate legal guardian or conservator of an adult, who is 
 15.19  not the responsible party and not the personal care provider 
 15.20  organization, may be granted a hardship waiver under section 
 15.21  256B.0627, to be reimbursed to provide personal care assistant 
 15.22  services to the recipient, and shall not be considered to have a 
 15.23  service provider interest for purposes of participation on the 
 15.24  screening team under section 256B.092, subdivision 7. 
 15.25     Sec. 15.  Minnesota Statutes 2000, section 256B.0625, 
 15.26  subdivision 19c, is amended to read: 
 15.27     Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
 15.28  personal care services provided by an individual who is 
 15.29  qualified to provide the services according to subdivision 19a 
 15.30  and section 256B.0627, where the services are prescribed by a 
 15.31  physician in accordance with a plan of treatment and are 
 15.32  supervised by the recipient under the fiscal agent option 
 15.33  according to section 256B.0627, subdivision 10, or a qualified 
 15.34  professional.  "Qualified professional" means a mental health 
 15.35  professional as defined in section 245.462, subdivision 18, or 
 15.36  245.4871, subdivision 27; or a registered nurse as defined in 
 16.1   sections 148.171 to 148.285.  As part of the assessment, the 
 16.2   county public health nurse will consult with assist the 
 16.3   recipient or responsible party and to identify the most 
 16.4   appropriate person to provide supervision of the personal care 
 16.5   assistant.  The qualified professional shall perform the duties 
 16.6   described in Minnesota Rules, part 9505.0335, subpart 4.  
 16.7      Sec. 16.  Minnesota Statutes 2000, section 256B.0625, 
 16.8   subdivision 20, is amended to read: 
 16.9      Subd. 20.  [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 
 16.10  extent authorized by rule of the state agency, medical 
 16.11  assistance covers case management services to persons with 
 16.12  serious and persistent mental illness and children with severe 
 16.13  emotional disturbance.  Services provided under this section 
 16.14  must meet the relevant standards in sections 245.461 to 
 16.15  245.4888, the Comprehensive Adult and Children's Mental Health 
 16.16  Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 
 16.17  9505.0322, excluding subpart 10. 
 16.18     (b) Entities meeting program standards set out in rules 
 16.19  governing family community support services as defined in 
 16.20  section 245.4871, subdivision 17, are eligible for medical 
 16.21  assistance reimbursement for case management services for 
 16.22  children with severe emotional disturbance when these services 
 16.23  meet the program standards in Minnesota Rules, parts 9520.0900 
 16.24  to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 
 16.25     (c) Medical assistance and MinnesotaCare payment for mental 
 16.26  health case management shall be made on a monthly basis.  In 
 16.27  order to receive payment for an eligible child, the provider 
 16.28  must document at least a face-to-face contact with the child, 
 16.29  the child's parents, or the child's legal representative.  To 
 16.30  receive payment for an eligible adult, the provider must 
 16.31  document: 
 16.32     (1) at least a face-to-face contact with the adult or the 
 16.33  adult's legal representative; or 
 16.34     (2) at least a telephone contact with the adult or the 
 16.35  adult's legal representative and document a face-to-face contact 
 16.36  with the adult or the adult's legal representative within the 
 17.1   preceding two months. 
 17.2      (d) Payment for mental health case management provided by 
 17.3   county or state staff shall be based on the monthly rate 
 17.4   methodology under section 256B.094, subdivision 6, paragraph 
 17.5   (b), with separate rates calculated for child welfare and mental 
 17.6   health, and within mental health, separate rates for children 
 17.7   and adults. 
 17.8      (e) Payment for mental health case management provided by 
 17.9   county-contracted vendors shall be based on a monthly rate 
 17.10  negotiated by the host county.  The negotiated rate must not 
 17.11  exceed the rate charged by the vendor for the same service to 
 17.12  other payers.  If the service is provided by a team of 
 17.13  contracted vendors, the county may negotiate a team rate with a 
 17.14  vendor who is a member of the team.  The team shall determine 
 17.15  how to distribute the rate among its members.  No reimbursement 
 17.16  received by contracted vendors shall be returned to the county, 
 17.17  except to reimburse the county for advance funding provided by 
 17.18  the county to the vendor. 
 17.19     (f) If the service is provided by a team which includes 
 17.20  contracted vendors and county or state staff, the costs for 
 17.21  county or state staff participation in the team shall be 
 17.22  included in the rate for county-provided services.  In this 
 17.23  case, the contracted vendor and the county may each receive 
 17.24  separate payment for services provided by each entity in the 
 17.25  same month.  In order to prevent duplication of services, the 
 17.26  county must document, in the recipient's file, the need for team 
 17.27  case management and a description of the roles of the team 
 17.28  members. 
 17.29     (g) The commissioner shall calculate the nonfederal share 
 17.30  of actual medical assistance and general assistance medical care 
 17.31  payments for each county, based on the higher of calendar year 
 17.32  1995 or 1996, by service date, project that amount forward to 
 17.33  1999, and transfer one-half of the result from medical 
 17.34  assistance and general assistance medical care to each county's 
 17.35  mental health grants under sections 245.4886 and 256E.12 for 
 17.36  calendar year 1999.  The annualized minimum amount added to each 
 18.1   county's mental health grant shall be $3,000 per year for 
 18.2   children and $5,000 per year for adults.  The commissioner may 
 18.3   reduce the statewide growth factor in order to fund these 
 18.4   minimums.  The annualized total amount transferred shall become 
 18.5   part of the base for future mental health grants for each county.
 18.6      (h) Any net increase in revenue to the county as a result 
 18.7   of the change in this section must be used to provide expanded 
 18.8   mental health services as defined in sections 245.461 to 
 18.9   245.4888, the Comprehensive Adult and Children's Mental Health 
 18.10  Acts, excluding inpatient and residential treatment.  For 
 18.11  adults, increased revenue may also be used for services and 
 18.12  consumer supports which are part of adult mental health projects 
 18.13  approved under Laws 1997, chapter 203, article 7, section 25.  
 18.14  For children, increased revenue may also be used for respite 
 18.15  care and nonresidential individualized rehabilitation services 
 18.16  as defined in section 245.492, subdivisions 17 and 23.  
 18.17  "Increased revenue" has the meaning given in Minnesota Rules, 
 18.18  part 9520.0903, subpart 3.  
 18.19     (i) Notwithstanding section 256B.19, subdivision 1, the 
 18.20  nonfederal share of costs for mental health case management 
 18.21  shall be provided by the recipient's county of responsibility, 
 18.22  as defined in sections 256G.01 to 256G.12, from sources other 
 18.23  than federal funds or funds used to match other federal funds.  
 18.24     (j) The commissioner may suspend, reduce, or terminate the 
 18.25  reimbursement to a provider that does not meet the reporting or 
 18.26  other requirements of this section.  The county of 
 18.27  responsibility, as defined in sections 256G.01 to 256G.12, is 
 18.28  responsible for any federal disallowances.  The county may share 
 18.29  this responsibility with its contracted vendors.  
 18.30     (k) The commissioner shall set aside a portion of the 
 18.31  federal funds earned under this section to repay the special 
 18.32  revenue maximization account under section 256.01, subdivision 
 18.33  2, clause (15).  The repayment is limited to: 
 18.34     (1) the costs of developing and implementing this section; 
 18.35  and 
 18.36     (2) programming the information systems. 
 19.1      (l) Notwithstanding section 256.025, subdivision 2, 
 19.2   payments to counties for case management expenditures under this 
 19.3   section shall only be made from federal earnings from services 
 19.4   provided under this section.  Payments to contracted vendors 
 19.5   shall include both the federal earnings and the county share. 
 19.6      (m) Notwithstanding section 256B.041, county payments for 
 19.7   the cost of mental health case management services provided by 
 19.8   county or state staff shall not be made to the state treasurer.  
 19.9   For the purposes of mental health case management services 
 19.10  provided by county or state staff under this section, the 
 19.11  centralized disbursement of payments to counties under section 
 19.12  256B.041 consists only of federal earnings from services 
 19.13  provided under this section. 
 19.14     (n) Case management services under this subdivision do not 
 19.15  include therapy, treatment, legal, or outreach services. 
 19.16     (o) If the recipient is a resident of a nursing facility, 
 19.17  intermediate care facility, or hospital, and the recipient's 
 19.18  institutional care is paid by medical assistance, payment for 
 19.19  case management services under this subdivision is limited to 
 19.20  the last 30 180 days of the recipient's residency in that 
 19.21  facility and may not exceed more than two six months in a 
 19.22  calendar year. 
 19.23     (p) Payment for case management services under this 
 19.24  subdivision shall not duplicate payments made under other 
 19.25  program authorities for the same purpose. 
 19.26     (q) By July 1, 2000, the commissioner shall evaluate the 
 19.27  effectiveness of the changes required by this section, including 
 19.28  changes in number of persons receiving mental health case 
 19.29  management, changes in hours of service per person, and changes 
 19.30  in caseload size. 
 19.31     (r) For each calendar year beginning with the calendar year 
 19.32  2001, the annualized amount of state funds for each county 
 19.33  determined under paragraph (g) shall be adjusted by the county's 
 19.34  percentage change in the average number of clients per month who 
 19.35  received case management under this section during the fiscal 
 19.36  year that ended six months prior to the calendar year in 
 20.1   question, in comparison to the prior fiscal year. 
 20.2      (s) For counties receiving the minimum allocation of $3,000 
 20.3   or $5,000 described in paragraph (g), the adjustment in 
 20.4   paragraph (r) shall be determined so that the county receives 
 20.5   the higher of the following amounts: 
 20.6      (1) a continuation of the minimum allocation in paragraph 
 20.7   (g); or 
 20.8      (2) an amount based on that county's average number of 
 20.9   clients per month who received case management under this 
 20.10  section during the fiscal year that ended six months prior to 
 20.11  the calendar year in question, in comparison to the prior fiscal 
 20.12  year, times the average statewide grant per person per month for 
 20.13  counties not receiving the minimum allocation. 
 20.14     (t) The adjustments in paragraphs (r) and (s) shall be 
 20.15  calculated separately for children and adults. 
 20.16     Sec. 17.  Minnesota Statutes 2000, section 256B.0625, is 
 20.17  amended by adding a subdivision to read: 
 20.18     Subd. 43.  [TARGETED CASE MANAGEMENT.] (a) For purposes of 
 20.19  this section, the following terms have the meanings given them: 
 20.20     (1) "Home care service recipients" means those individuals 
 20.21  receiving the following services under section 256B.0627:  
 20.22  skilled nursing visits, home health aide visits, private duty 
 20.23  nursing, personal care attendants, or therapies provided through 
 20.24  a home health agency. 
 20.25     (2) "Home care targeted case management" means the 
 20.26  provision of targeted case management services for the purpose 
 20.27  of assisting home care service recipients to gain access to 
 20.28  needed services and supports so that they may remain in the 
 20.29  community. 
 20.30     (3) "Institutions" means hospitals, consistent with Code of 
 20.31  Federal Regulations, title 42, section 440.10; regional 
 20.32  treatment center inpatient services, consistent with Minnesota 
 20.33  Statutes, section 245.474; nursing facilities; and intermediate 
 20.34  care facilities for people with mental retardation. 
 20.35     (4) "Relocation targeted case management" means the 
 20.36  provision of targeted case management services for the purpose 
 21.1   of assisting recipients to gain access to needed services and 
 21.2   supports if they choose to move from an institution to the 
 21.3   community.  Relocation targeted case management may be provided 
 21.4   during the last 180 consecutive days of an eligible recipient's 
 21.5   institutional stay. 
 21.6      (5) "Targeted case management" means case management 
 21.7   services provided to help recipients gain access to needed 
 21.8   medical, social, educational, and other services and supports. 
 21.9      (b) The following persons are eligible for relocation 
 21.10  targeted case management or home care targeted case management: 
 21.11     (1) Medical assistance eligible persons residing in 
 21.12  institutions who choose to move into the community are eligible 
 21.13  for relocation case management services. 
 21.14     (2) Medical assistance eligible persons receiving home care 
 21.15  services, who are not eligible for any other medical assistance 
 21.16  reimbursable case management service, are eligible for home care 
 21.17  targeted case management services beginning January 1, 2003.  
 21.18     (c) A provider of targeted case management under 
 21.19  subdivision 20 may be deemed a certified provider of relocation 
 21.20  targeted case management. 
 21.21     (d) The following provider qualifications and certification 
 21.22  standards must be met: 
 21.23     The commissioner must certify each provider of relocation 
 21.24  targeted case management or home care targeted case management 
 21.25  before enrollment.  The certification process shall examine the 
 21.26  provider's ability to meet the requirements in this subdivision 
 21.27  and other state and federal requirements of this service.  A 
 21.28  relocation targeted case management provider or a home care 
 21.29  targeted case management provider is an enrolled medical 
 21.30  assistance provider who has a minimum of a bachelor's degree, a 
 21.31  license in a health or human services field, and is determined 
 21.32  by the commissioner to have all of the following characteristics:
 21.33     (i) the demonstrated capacity and experience to provide the 
 21.34  components of case management to coordinate and link community 
 21.35  resources needed by the eligible population; 
 21.36     (ii) the administrative capacity and experience to serve 
 22.1   the target population for whom it will provide services and 
 22.2   ensure quality of services under state and federal requirements; 
 22.3      (iii) a financial management system that provides accurate 
 22.4   documentation of services and costs under state and federal 
 22.5   requirements; 
 22.6      (iv) the capacity to document and maintain individual case 
 22.7   records under state and federal requirements; and 
 22.8      (v) the capacity to coordinate with county administrative 
 22.9   functions. 
 22.10     (d) Services eligible for medical assistance reimbursement 
 22.11  include: 
 22.12     (1) assessment of the recipient's need for targeted case 
 22.13  management services; 
 22.14     (2) development, completion, and regular review of a 
 22.15  written individual service plan, which is based upon the 
 22.16  assessment of the recipient's needs and choices, and which will 
 22.17  ensure access to medical, social, educational, and other related 
 22.18  services and supports; 
 22.19     (3) routine contact or communication with the recipient, 
 22.20  the recipient's family, primary caregiver, legal representative, 
 22.21  substitute care provider, service providers, or other relevant 
 22.22  persons identified as necessary to the development or 
 22.23  implementation of the goals of the individual service plan; 
 22.24     (4) coordinating referrals for, and the provision of, case 
 22.25  management services for the recipient with appropriate service 
 22.26  providers, consistent with section 1902(a)(23) of the Social 
 22.27  Security Act; 
 22.28     (5) coordinating and monitoring the overall service 
 22.29  delivery to ensure quality of services, appropriateness, and 
 22.30  continued need; 
 22.31     (6) completing and maintaining necessary documentation that 
 22.32  supports and verifies the activities in this subdivision; 
 22.33     (7) traveling to conduct a visit with the recipient or 
 22.34  other relevant person necessary to develop or implement the 
 22.35  goals of the individual service plan; and 
 22.36     (8) coordinating with the institution discharge planner in 
 23.1   the 180-day period before the recipient's discharge. 
 23.2      (e) The following time lines must be met for assigning a 
 23.3   case manager: 
 23.4      (1) For relocation targeted case management, an eligible 
 23.5   recipient must be assigned a case manager within 30 days of 
 23.6   requesting one. 
 23.7      (2) For home care targeted case management, an eligible 
 23.8   recipient must be assigned a case manager within 30 days of 
 23.9   requesting one from a home care targeted case management 
 23.10  provider, as defined in paragraph (c), clause (2). 
 23.11     (f) The commissioner shall evaluate the delivery of 
 23.12  targeted case management, including, but not limited to, access 
 23.13  to case management services, consumer satisfaction with case 
 23.14  management services, and quality of case management services. 
 23.15     (g) The case manager must document each face-to-face and 
 23.16  telephone contact with the recipient and others involved in the 
 23.17  recipient's individual service plan. 
 23.18     (h) The commissioner shall set payment rates for targeted 
 23.19  case management under this subdivision.  Case managers may bill 
 23.20  according to the following criteria: 
 23.21     (1) For relocation targeted case management, case managers 
 23.22  may bill for direct case management activities, including 
 23.23  face-to-face and telephone contacts, in the 180 days preceding 
 23.24  an eligible recipient's discharge from an institution. 
 23.25     (2) For home care targeted case management, case managers 
 23.26  may bill for direct case management activities, including 
 23.27  face-to-face and telephone contacts. 
 23.28     (3) Billings for targeted case management services under 
 23.29  this subdivision shall not duplicate payments made under other 
 23.30  program authorities for the same purpose.  
 23.31     Sec. 18.  Minnesota Statutes 2000, section 256B.0627, 
 23.32  subdivision 1, is amended to read: 
 23.33     Subdivision 1.  [DEFINITION.] (a) "Activities of daily 
 23.34  living" includes eating, toileting, grooming, dressing, bathing, 
 23.35  transferring, mobility, and positioning.  
 23.36     (b) "Assessment" means a review and evaluation of a 
 24.1   recipient's need for home care services conducted in person.  
 24.2   Assessments for private duty nursing shall be conducted by a 
 24.3   registered private duty nurse.  Assessments for home health 
 24.4   agency services shall be conducted by a home health agency 
 24.5   nurse.  Assessments for personal care assistant services shall 
 24.6   be conducted by the county public health nurse or a certified 
 24.7   public health nurse under contract with the county.  A 
 24.8   face-to-face assessment must include:  documentation of health 
 24.9   status, determination of need, evaluation of service 
 24.10  effectiveness, identification of appropriate services, service 
 24.11  plan development or modification, coordination of services, 
 24.12  referrals and follow-up to appropriate payers and community 
 24.13  resources, completion of required reports, recommendation of 
 24.14  service authorization, and consumer education.  Once the need 
 24.15  for personal care assistant services is determined under this 
 24.16  section, the county public health nurse or certified public 
 24.17  health nurse under contract with the county is responsible for 
 24.18  communicating this recommendation to the commissioner and the 
 24.19  recipient.  A face-to-face assessment for personal care services 
 24.20  is conducted on those recipients who have never had a county 
 24.21  public health nurse assessment.  A face-to-face assessment must 
 24.22  occur at least annually or when there is a significant change in 
 24.23  the recipient's condition or when there is a change in the need 
 24.24  for personal care assistant services.  A service update may 
 24.25  substitute for the annual face-to-face assessment when there is 
 24.26  not a significant change in recipient condition or a change in 
 24.27  the need for personal care assistant service.  A service update 
 24.28  or review for temporary increase includes a review of initial 
 24.29  baseline data, evaluation of service effectiveness, 
 24.30  redetermination of service need, modification of service plan 
 24.31  and appropriate referrals, update of initial forms, obtaining 
 24.32  service authorization, and on going consumer education.  
 24.33  Assessments for medical assistance home care services for mental 
 24.34  retardation or related conditions and alternative care services 
 24.35  for developmentally disabled home and community-based waivered 
 24.36  recipients may be conducted by the county public health nurse to 
 25.1   ensure coordination and avoid duplication.  Assessments must be 
 25.2   completed on forms provided by the commissioner within 30 days 
 25.3   of a request for home care services by a recipient or 
 25.4   responsible party. 
 25.5      (b) (c) "Care plan" means a written description of personal 
 25.6   care assistant services developed by the qualified 
 25.7   professional or the recipient's physician with the recipient or 
 25.8   responsible party to be used by the personal care assistant with 
 25.9   a copy provided to the recipient or responsible party. 
 25.10     (d) "Complex and regular private duty nursing care" means, 
 25.11  effective January 1, 2003:  
 25.12     (1) complex care is private duty nursing provided to 
 25.13  recipients who are ventilator dependent or for whom a physician 
 25.14  has certified that were it not for private duty nursing the 
 25.15  recipient would meet the criteria for inpatient hospital 
 25.16  intensive care unit (ICU) level of care; and 
 25.17     (2) regular care is private duty nursing provided to all 
 25.18  other recipients. 
 25.19     (e) "Health-related functions" means functions that can be 
 25.20  delegated or assigned by a licensed health care professional 
 25.21  under state law to be performed by a personal care attendant. 
 25.22     (c) (f) "Home care services" means a health service, 
 25.23  determined by the commissioner as medically necessary, that is 
 25.24  ordered by a physician and documented in a service plan that is 
 25.25  reviewed by the physician at least once every 62 60 days for the 
 25.26  provision of home health services, or private duty nursing, or 
 25.27  at least once every 365 days for personal care.  Home care 
 25.28  services are provided to the recipient at the recipient's 
 25.29  residence that is a place other than a hospital or long-term 
 25.30  care facility or as specified in section 256B.0625.  
 25.31     (g) "Instrumental activities of daily living" includes meal 
 25.32  planning and preparation, managing finances, shopping for food, 
 25.33  clothing, and other essential items, performing essential 
 25.34  household chores, communication by telephone and other media, 
 25.35  and getting around and participating in the community. 
 25.36     (d) (h) "Medically necessary" has the meaning given in 
 26.1   Minnesota Rules, parts 9505.0170 to 9505.0475.  
 26.2      (e) (i) "Personal care assistant" means a person who:  
 26.3      (1) is at least 18 years old, except for persons 16 to 18 
 26.4   years of age who participated in a related school-based job 
 26.5   training program or have completed a certified home health aide 
 26.6   competency evaluation; 
 26.7      (2) is able to effectively communicate with the recipient 
 26.8   and personal care provider organization; 
 26.9      (3) effective July 1, 1996, has completed one of the 
 26.10  training requirements as specified in Minnesota Rules, part 
 26.11  9505.0335, subpart 3, items A to D; 
 26.12     (4) has the ability to, and provides covered personal care 
 26.13  services according to the recipient's care plan, responds 
 26.14  appropriately to recipient needs, and reports changes in the 
 26.15  recipient's condition to the supervising qualified 
 26.16  professional or physician; 
 26.17     (5) is not a consumer of personal care services; and 
 26.18     (6) is subject to criminal background checks and procedures 
 26.19  specified in section 245A.04.  
 26.20     (f) (j) "Personal care provider organization" means an 
 26.21  organization enrolled to provide personal care assistant 
 26.22  services under the medical assistance program that complies with 
 26.23  the following:  (1) owners who have a five percent interest or 
 26.24  more, and managerial officials are subject to a background study 
 26.25  as provided in section 245A.04.  This applies to currently 
 26.26  enrolled personal care provider organizations and those agencies 
 26.27  seeking enrollment as a personal care provider organization.  An 
 26.28  organization will be barred from enrollment if an owner or 
 26.29  managerial official of the organization has been convicted of a 
 26.30  crime specified in section 245A.04, or a comparable crime in 
 26.31  another jurisdiction, unless the owner or managerial official 
 26.32  meets the reconsideration criteria specified in section 245A.04; 
 26.33  (2) the organization must maintain a surety bond and liability 
 26.34  insurance throughout the duration of enrollment and provides 
 26.35  proof thereof.  The insurer must notify the department of human 
 26.36  services of the cancellation or lapse of policy; and (3) the 
 27.1   organization must maintain documentation of services as 
 27.2   specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
 27.3   as evidence of compliance with personal care assistant training 
 27.4   requirements. 
 27.5      (g) (k) "Responsible party" means an individual residing 
 27.6   with a recipient of personal care assistant services who is 
 27.7   capable of providing the supportive care necessary to assist the 
 27.8   recipient to live in the community, is at least 18 years old, 
 27.9   and is not a personal care assistant.  Responsible parties who 
 27.10  are parents of minors or guardians of minors or incapacitated 
 27.11  persons may delegate the responsibility to another adult during 
 27.12  a temporary absence of at least 24 hours but not more than six 
 27.13  months.  The person delegated as a responsible party must be 
 27.14  able to meet the definition of responsible party, except that 
 27.15  the delegated responsible party is required to reside with the 
 27.16  recipient only while serving as the responsible party.  Foster 
 27.17  care license holders may be designated the responsible party for 
 27.18  residents of the foster care home if case management is provided 
 27.19  as required in section 256B.0625, subdivision 19a.  For persons 
 27.20  who, as of April 1, 1992, are sharing personal care assistant 
 27.21  services in order to obtain the availability of 24-hour 
 27.22  coverage, an employee of the personal care provider organization 
 27.23  may be designated as the responsible party if case management is 
 27.24  provided as required in section 256B.0625, subdivision 19a. 
 27.25     (h) (l) "Service plan" means a written description of the 
 27.26  services needed based on the assessment developed by the nurse 
 27.27  who conducts the assessment together with the recipient or 
 27.28  responsible party.  The service plan shall include a description 
 27.29  of the covered home care services, frequency and duration of 
 27.30  services, and expected outcomes and goals.  The recipient and 
 27.31  the provider chosen by the recipient or responsible party must 
 27.32  be given a copy of the completed service plan within 30 calendar 
 27.33  days of the request for home care services by the recipient or 
 27.34  responsible party. 
 27.35     (i) (m) "Skilled nurse visits" are provided in a 
 27.36  recipient's residence under a plan of care or service plan that 
 28.1   specifies a level of care which the nurse is qualified to 
 28.2   provide.  These services are: 
 28.3      (1) nursing services according to the written plan of care 
 28.4   or service plan and accepted standards of medical and nursing 
 28.5   practice in accordance with chapter 148; 
 28.6      (2) services which due to the recipient's medical condition 
 28.7   may only be safely and effectively provided by a registered 
 28.8   nurse or a licensed practical nurse; 
 28.9      (3) assessments performed only by a registered nurse; and 
 28.10     (4) teaching and training the recipient, the recipient's 
 28.11  family, or other caregivers requiring the skills of a registered 
 28.12  nurse or licensed practical nurse. 
 28.13     (n) "Telehomecare" means the use of telecommunications 
 28.14  technology by a home health care professional to deliver home 
 28.15  health care services, within the professional's scope of 
 28.16  practice, to a patient located at a site other than the site 
 28.17  where the practitioner is located. 
 28.18     Sec. 19.  Minnesota Statutes 2000, section 256B.0627, 
 28.19  subdivision 2, is amended to read: 
 28.20     Subd. 2.  [SERVICES COVERED.] Home care services covered 
 28.21  under this section include:  
 28.22     (1) nursing services under section 256B.0625, subdivision 
 28.23  6a; 
 28.24     (2) private duty nursing services under section 256B.0625, 
 28.25  subdivision 7; 
 28.26     (3) home health aide services under section 256B.0625, 
 28.27  subdivision 6a; 
 28.28     (4) personal care services under section 256B.0625, 
 28.29  subdivision 19a; 
 28.30     (5) supervision of personal care assistant services 
 28.31  provided by a qualified professional under section 256B.0625, 
 28.32  subdivision 19a; 
 28.33     (6) consulting qualified professional of personal care 
 28.34  assistant services under the fiscal agent intermediary option as 
 28.35  specified in subdivision 10; 
 28.36     (7) face-to-face assessments by county public health nurses 
 29.1   for services under section 256B.0625, subdivision 19a; and 
 29.2      (8) service updates and review of temporary increases for 
 29.3   personal care assistant services by the county public health 
 29.4   nurse for services under section 256B.0625, subdivision 19a. 
 29.5      Sec. 20.  Minnesota Statutes 2000, section 256B.0627, 
 29.6   subdivision 4, is amended to read: 
 29.7      Subd. 4.  [PERSONAL CARE SERVICES.] (a) The personal care 
 29.8   services that are eligible for payment are the 
 29.9   following: services and supports furnished to an individual, as 
 29.10  needed, to assist in accomplishing activities of daily living; 
 29.11  instrumental activities of daily living; health-related 
 29.12  functions through hands-on assistance, supervision, and cuing; 
 29.13  and redirection and intervention for behavior including 
 29.14  observation and monitoring.  
 29.15     (b) Payment for services will be made within the limits 
 29.16  approved using the prior authorized process established in 
 29.17  subdivision 5. 
 29.18     (c) The amount and type of services authorized shall be 
 29.19  based on an assessment of the recipient's needs in these areas: 
 29.20     (1) bowel and bladder care; 
 29.21     (2) skin care to maintain the health of the skin; 
 29.22     (3) repetitive maintenance range of motion, muscle 
 29.23  strengthening exercises, and other tasks specific to maintaining 
 29.24  a recipient's optimal level of function; 
 29.25     (4) respiratory assistance; 
 29.26     (5) transfers and ambulation; 
 29.27     (6) bathing, grooming, and hairwashing necessary for 
 29.28  personal hygiene; 
 29.29     (7) turning and positioning; 
 29.30     (8) assistance with furnishing medication that is 
 29.31  self-administered; 
 29.32     (9) application and maintenance of prosthetics and 
 29.33  orthotics; 
 29.34     (10) cleaning medical equipment; 
 29.35     (11) dressing or undressing; 
 29.36     (12) assistance with eating and meal preparation and 
 30.1   necessary grocery shopping; 
 30.2      (13) accompanying a recipient to obtain medical diagnosis 
 30.3   or treatment; 
 30.4      (14) assisting, monitoring, or prompting the recipient to 
 30.5   complete the services in clauses (1) to (13); 
 30.6      (15) redirection, monitoring, and observation that are 
 30.7   medically necessary and an integral part of completing the 
 30.8   personal care services described in clauses (1) to (14); 
 30.9      (16) redirection and intervention for behavior, including 
 30.10  observation and monitoring; 
 30.11     (17) interventions for seizure disorders, including 
 30.12  monitoring and observation if the recipient has had a seizure 
 30.13  that requires intervention within the past three months; 
 30.14     (18) tracheostomy suctioning using a clean procedure if the 
 30.15  procedure is properly delegated by a registered nurse.  Before 
 30.16  this procedure can be delegated to a personal care assistant, a 
 30.17  registered nurse must determine that the tracheostomy suctioning 
 30.18  can be accomplished utilizing a clean rather than a sterile 
 30.19  procedure and must ensure that the personal care assistant has 
 30.20  been taught the proper procedure; and 
 30.21     (19) incidental household services that are an integral 
 30.22  part of a personal care service described in clauses (1) to (18).
 30.23  For purposes of this subdivision, monitoring and observation 
 30.24  means watching for outward visible signs that are likely to 
 30.25  occur and for which there is a covered personal care service or 
 30.26  an appropriate personal care intervention.  For purposes of this 
 30.27  subdivision, a clean procedure refers to a procedure that 
 30.28  reduces the numbers of microorganisms or prevents or reduces the 
 30.29  transmission of microorganisms from one person or place to 
 30.30  another.  A clean procedure may be used beginning 14 days after 
 30.31  insertion. 
 30.32     (b) (d) The personal care assistant services that are not 
 30.33  eligible for payment are the following:  
 30.34     (1) services not ordered by the physician; 
 30.35     (2) assessments by personal care assistant provider 
 30.36  organizations or by independently enrolled registered nurses; 
 31.1      (3) services that are not in the service plan; 
 31.2      (4) services provided by the recipient's spouse, legal 
 31.3   guardian for an adult or child recipient, or parent of a 
 31.4   recipient under age 18; 
 31.5      (5) services provided by a foster care provider of a 
 31.6   recipient who cannot direct the recipient's own care, unless 
 31.7   monitored by a county or state case manager under section 
 31.8   256B.0625, subdivision 19a; 
 31.9      (6) services provided by the residential or program license 
 31.10  holder in a residence for more than four persons; 
 31.11     (7) services that are the responsibility of a residential 
 31.12  or program license holder under the terms of a service agreement 
 31.13  and administrative rules; 
 31.14     (8) sterile procedures; 
 31.15     (9) injections of fluids into veins, muscles, or skin; 
 31.16     (10) services provided by parents of adult recipients, 
 31.17  adult children, or siblings of the recipient, unless these 
 31.18  relatives meet one of the following hardship criteria and the 
 31.19  commissioner waives this requirement: 
 31.20     (i) the relative resigns from a part-time or full-time job 
 31.21  to provide personal care for the recipient; 
 31.22     (ii) the relative goes from a full-time to a part-time job 
 31.23  with less compensation to provide personal care for the 
 31.24  recipient; 
 31.25     (iii) the relative takes a leave of absence without pay to 
 31.26  provide personal care for the recipient; 
 31.27     (iv) the relative incurs substantial expenses by providing 
 31.28  personal care for the recipient; or 
 31.29     (v) because of labor conditions, special language needs, or 
 31.30  intermittent hours of care needed, the relative is needed in 
 31.31  order to provide an adequate number of qualified personal care 
 31.32  assistants to meet the medical needs of the recipient; 
 31.33     (11) homemaker services that are not an integral part of a 
 31.34  personal care assistant services; 
 31.35     (12) home maintenance, or chore services; 
 31.36     (13) services not specified under paragraph (a); and 
 32.1      (14) services not authorized by the commissioner or the 
 32.2   commissioner's designee. 
 32.3      (e) The recipient or responsible party may choose to 
 32.4   supervise the personal care assistant or to have a qualified 
 32.5   professional, as defined in section 256B.0625, subdivision 19c, 
 32.6   provide the supervision.  As required under section 256B.0625, 
 32.7   subdivision 19c, the county public health nurse, as a part of 
 32.8   the assessment, will assist the recipient or responsible party 
 32.9   to identify the most appropriate person to provide supervision 
 32.10  of the personal care assistant.  Health-related delegated tasks 
 32.11  performed by the personal care assistant will be under the 
 32.12  supervision of a qualified professional or the direction of the 
 32.13  recipient's physician.  If the recipient has a qualified 
 32.14  professional, Minnesota Rules, part 9505.0335, subpart 4, 
 32.15  applies. 
 32.16     Sec. 21.  Minnesota Statutes 2000, section 256B.0627, 
 32.17  subdivision 5, is amended to read: 
 32.18     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
 32.19  payments for home care services shall be limited according to 
 32.20  this subdivision.  
 32.21     (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
 32.22  recipient may receive the following home care services during a 
 32.23  calendar year: 
 32.24     (1) up to two face-to-face assessments to determine a 
 32.25  recipient's need for personal care assistant services; 
 32.26     (2) one service update done to determine a recipient's need 
 32.27  for personal care services; and 
 32.28     (3) up to five nine skilled nurse visits.  
 32.29     (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
 32.30  services above the limits in paragraph (a) must receive the 
 32.31  commissioner's prior authorization, except when: 
 32.32     (1) the home care services were required to treat an 
 32.33  emergency medical condition that if not immediately treated 
 32.34  could cause a recipient serious physical or mental disability, 
 32.35  continuation of severe pain, or death.  The provider must 
 32.36  request retroactive authorization no later than five working 
 33.1   days after giving the initial service.  The provider must be 
 33.2   able to substantiate the emergency by documentation such as 
 33.3   reports, notes, and admission or discharge histories; 
 33.4      (2) the home care services were provided on or after the 
 33.5   date on which the recipient's eligibility began, but before the 
 33.6   date on which the recipient was notified that the case was 
 33.7   opened.  Authorization will be considered if the request is 
 33.8   submitted by the provider within 20 working days of the date the 
 33.9   recipient was notified that the case was opened; 
 33.10     (3) a third-party payor for home care services has denied 
 33.11  or adjusted a payment.  Authorization requests must be submitted 
 33.12  by the provider within 20 working days of the notice of denial 
 33.13  or adjustment.  A copy of the notice must be included with the 
 33.14  request; 
 33.15     (4) the commissioner has determined that a county or state 
 33.16  human services agency has made an error; or 
 33.17     (5) the professional nurse determines an immediate need for 
 33.18  up to 40 skilled nursing or home health aide visits per calendar 
 33.19  year and submits a request for authorization within 20 working 
 33.20  days of the initial service date, and medical assistance is 
 33.21  determined to be the appropriate payer. 
 33.22     (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
 33.23  authorization will be evaluated according to the same criteria 
 33.24  applied to prior authorization requests.  
 33.25     (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
 33.26  section 256B.0627, subdivision 1, paragraph (a), shall be 
 33.27  conducted initially, and at least annually thereafter, in person 
 33.28  with the recipient and result in a completed service plan using 
 33.29  forms specified by the commissioner.  Within 30 days of 
 33.30  recipient or responsible party request for home care services, 
 33.31  the assessment, the service plan, and other information 
 33.32  necessary to determine medical necessity such as diagnostic or 
 33.33  testing information, social or medical histories, and hospital 
 33.34  or facility discharge summaries shall be submitted to the 
 33.35  commissioner.  For personal care services: 
 33.36     (1) The amount and type of service authorized based upon 
 34.1   the assessment and service plan will follow the recipient if the 
 34.2   recipient chooses to change providers.  
 34.3      (2) If the recipient's medical need changes, the 
 34.4   recipient's provider may assess the need for a change in service 
 34.5   authorization and request the change from the county public 
 34.6   health nurse.  Within 30 days of the request, the public health 
 34.7   nurse will determine whether to request the change in services 
 34.8   based upon the provider assessment, or conduct a home visit to 
 34.9   assess the need and determine whether the change is appropriate. 
 34.10     (3) To continue to receive personal care services after the 
 34.11  first year, the recipient or the responsible party, in 
 34.12  conjunction with the public health nurse, may complete a service 
 34.13  update on forms developed by the commissioner according to 
 34.14  criteria and procedures in subdivision 1.  
 34.15     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
 34.16  commissioner's designee, shall review the assessment, service 
 34.17  update, request for temporary services, service plan, and any 
 34.18  additional information that is submitted.  The commissioner 
 34.19  shall, within 30 days after receiving a complete request, 
 34.20  assessment, and service plan, authorize home care services as 
 34.21  follows:  
 34.22     (1)  [HOME HEALTH SERVICES.] All home health services 
 34.23  provided by a licensed nurse or a home health aide must be prior 
 34.24  authorized by the commissioner or the commissioner's designee.  
 34.25  Prior authorization must be based on medical necessity and 
 34.26  cost-effectiveness when compared with other care options.  When 
 34.27  home health services are used in combination with personal care 
 34.28  and private duty nursing, the cost of all home care services 
 34.29  shall be considered for cost-effectiveness.  The commissioner 
 34.30  shall limit nurse and home health aide visits to no more than 
 34.31  one visit each per day.  The commissioner, or the commissioner's 
 34.32  designee, may authorize up to two home health aide or skilled 
 34.33  nurse visits per day. 
 34.34     (2)  [PERSONAL CARE SERVICES.] (i) All personal care 
 34.35  services and supervision by a qualified professional, if 
 34.36  requested by the recipient, must be prior authorized by the 
 35.1   commissioner or the commissioner's designee except for the 
 35.2   assessments established in paragraph (a).  The amount of 
 35.3   personal care services authorized must be based on the 
 35.4   recipient's home care rating.  A child may not be found to be 
 35.5   dependent in an activity of daily living if because of the 
 35.6   child's age an adult would either perform the activity for the 
 35.7   child or assist the child with the activity and the amount of 
 35.8   assistance needed is similar to the assistance appropriate for a 
 35.9   typical child of the same age.  Based on medical necessity, the 
 35.10  commissioner may authorize: 
 35.11     (A) up to two times the average number of direct care hours 
 35.12  provided in nursing facilities for the recipient's comparable 
 35.13  case mix level; or 
 35.14     (B) up to three times the average number of direct care 
 35.15  hours provided in nursing facilities for recipients who have 
 35.16  complex medical needs or are dependent in at least seven 
 35.17  activities of daily living and need physical assistance with 
 35.18  eating or have a neurological diagnosis; or 
 35.19     (C) up to 60 percent of the average reimbursement rate, as 
 35.20  of July 1, 1991, for care provided in a regional treatment 
 35.21  center for recipients who have Level I behavior, plus any 
 35.22  inflation adjustment as provided by the legislature for personal 
 35.23  care service; or 
 35.24     (D) up to the amount the commissioner would pay, as of July 
 35.25  1, 1991, plus any inflation adjustment provided for home care 
 35.26  services, for care provided in a regional treatment center for 
 35.27  recipients referred to the commissioner by a regional treatment 
 35.28  center preadmission evaluation team.  For purposes of this 
 35.29  clause, home care services means all services provided in the 
 35.30  home or community that would be included in the payment to a 
 35.31  regional treatment center; or 
 35.32     (E) up to the amount medical assistance would reimburse for 
 35.33  facility care for recipients referred to the commissioner by a 
 35.34  preadmission screening team established under section 256B.0911 
 35.35  or 256B.092; and 
 35.36     (F) a reasonable amount of time for the provision of 
 36.1   supervision by a qualified professional of personal 
 36.2   care assistant services, if a qualified professional is 
 36.3   requested by the recipient or responsible party.  
 36.4      (ii) The number of direct care hours shall be determined 
 36.5   according to the annual cost report submitted to the department 
 36.6   by nursing facilities.  The average number of direct care hours, 
 36.7   as established by May 1, 1992, shall be calculated and 
 36.8   incorporated into the home care limits on July 1, 1992.  These 
 36.9   limits shall be calculated to the nearest quarter hour. 
 36.10     (iii) The home care rating shall be determined by the 
 36.11  commissioner or the commissioner's designee based on information 
 36.12  submitted to the commissioner by the county public health nurse 
 36.13  on forms specified by the commissioner.  The home care rating 
 36.14  shall be a combination of current assessment tools developed 
 36.15  under sections 256B.0911 and 256B.501 with an addition for 
 36.16  seizure activity that will assess the frequency and severity of 
 36.17  seizure activity and with adjustments, additions, and 
 36.18  clarifications that are necessary to reflect the needs and 
 36.19  conditions of recipients who need home care including children 
 36.20  and adults under 65 years of age.  The commissioner shall 
 36.21  establish these forms and protocols under this section and shall 
 36.22  use an advisory group, including representatives of recipients, 
 36.23  providers, and counties, for consultation in establishing and 
 36.24  revising the forms and protocols. 
 36.25     (iv) A recipient shall qualify as having complex medical 
 36.26  needs if the care required is difficult to perform and because 
 36.27  of recipient's medical condition requires more time than 
 36.28  community-based standards allow or requires more skill than 
 36.29  would ordinarily be required and the recipient needs or has one 
 36.30  or more of the following: 
 36.31     (A) daily tube feedings; 
 36.32     (B) daily parenteral therapy; 
 36.33     (C) wound or decubiti care; 
 36.34     (D) postural drainage, percussion, nebulizer treatments, 
 36.35  suctioning, tracheotomy care, oxygen, mechanical ventilation; 
 36.36     (E) catheterization; 
 37.1      (F) ostomy care; 
 37.2      (G) quadriplegia; or 
 37.3      (H) other comparable medical conditions or treatments the 
 37.4   commissioner determines would otherwise require institutional 
 37.5   care.  
 37.6      (v) A recipient shall qualify as having Level I behavior if 
 37.7   there is reasonable supporting evidence that the recipient 
 37.8   exhibits, or that without supervision, observation, or 
 37.9   redirection would exhibit, one or more of the following 
 37.10  behaviors that cause, or have the potential to cause: 
 37.11     (A) injury to the recipient's own body; 
 37.12     (B) physical injury to other people; or 
 37.13     (C) destruction of property. 
 37.14     (vi) Time authorized for personal care relating to Level I 
 37.15  behavior in subclause (v), items (A) to (C), shall be based on 
 37.16  the predictability, frequency, and amount of intervention 
 37.17  required. 
 37.18     (vii) A recipient shall qualify as having Level II behavior 
 37.19  if the recipient exhibits on a daily basis one or more of the 
 37.20  following behaviors that interfere with the completion of 
 37.21  personal care services under subdivision 4, paragraph (a): 
 37.22     (A) unusual or repetitive habits; 
 37.23     (B) withdrawn behavior; or 
 37.24     (C) offensive behavior. 
 37.25     (viii) A recipient with a home care rating of Level II 
 37.26  behavior in subclause (vii), items (A) to (C), shall be rated as 
 37.27  comparable to a recipient with complex medical needs under 
 37.28  subclause (iv).  If a recipient has both complex medical needs 
 37.29  and Level II behavior, the home care rating shall be the next 
 37.30  complex category up to the maximum rating under subclause (i), 
 37.31  item (B). 
 37.32     (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
 37.33  nursing services shall be prior authorized by the commissioner 
 37.34  or the commissioner's designee.  Prior authorization for private 
 37.35  duty nursing services shall be based on medical necessity and 
 37.36  cost-effectiveness when compared with alternative care options.  
 38.1   The commissioner may authorize medically necessary private duty 
 38.2   nursing services in quarter-hour units when: 
 38.3      (i) the recipient requires more individual and continuous 
 38.4   care than can be provided during a nurse visit; or 
 38.5      (ii) the cares are outside of the scope of services that 
 38.6   can be provided by a home health aide or personal care assistant.
 38.7      The commissioner may authorize: 
 38.8      (A) up to two times the average amount of direct care hours 
 38.9   provided in nursing facilities statewide for case mix 
 38.10  classification "K" as established by the annual cost report 
 38.11  submitted to the department by nursing facilities in May 1992; 
 38.12     (B) private duty nursing in combination with other home 
 38.13  care services up to the total cost allowed under clause (2); 
 38.14     (C) up to 16 hours per day if the recipient requires more 
 38.15  nursing than the maximum number of direct care hours as 
 38.16  established in item (A) and the recipient meets the hospital 
 38.17  admission criteria established under Minnesota Rules, parts 
 38.18  9505.0500 9505.0501 to 9505.0540.  
 38.19     The commissioner may authorize up to 16 hours per day of 
 38.20  medically necessary private duty nursing services or up to 24 
 38.21  hours per day of medically necessary private duty nursing 
 38.22  services until such time as the commissioner is able to make a 
 38.23  determination of eligibility for recipients who are 
 38.24  cooperatively applying for home care services under the 
 38.25  community alternative care program developed under section 
 38.26  256B.49, or until it is determined by the appropriate regulatory 
 38.27  agency that a health benefit plan is or is not required to pay 
 38.28  for appropriate medically necessary health care services.  
 38.29  Recipients or their representatives must cooperatively assist 
 38.30  the commissioner in obtaining this determination.  Recipients 
 38.31  who are eligible for the community alternative care program may 
 38.32  not receive more hours of nursing under this section than would 
 38.33  otherwise be authorized under section 256B.49.  
 38.34     Beginning July 1, 2001, private duty nursing services will 
 38.35  be authorized for complex and regular care according to section 
 38.36  256B.0627. 
 39.1      (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
 39.2   ventilator-dependent, the monthly medical assistance 
 39.3   authorization for home care services shall not exceed what the 
 39.4   commissioner would pay for care at the highest cost hospital 
 39.5   designated as a long-term hospital under the Medicare program.  
 39.6   For purposes of this clause, home care services means all 
 39.7   services provided in the home that would be included in the 
 39.8   payment for care at the long-term hospital.  
 39.9   "Ventilator-dependent" means an individual who receives 
 39.10  mechanical ventilation for life support at least six hours per 
 39.11  day and is expected to be or has been dependent for at least 30 
 39.12  consecutive days.  
 39.13     (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
 39.14  or the commissioner's designee shall determine the time period 
 39.15  for which a prior authorization shall be effective.  If the 
 39.16  recipient continues to require home care services beyond the 
 39.17  duration of the prior authorization, the home care provider must 
 39.18  request a new prior authorization.  Under no circumstances, 
 39.19  other than the exceptions in paragraph (b), shall a prior 
 39.20  authorization be valid prior to the date the commissioner 
 39.21  receives the request or for more than 12 months.  A recipient 
 39.22  who appeals a reduction in previously authorized home care 
 39.23  services may continue previously authorized services, other than 
 39.24  temporary services under paragraph (h), pending an appeal under 
 39.25  section 256.045.  The commissioner must provide a detailed 
 39.26  explanation of why the authorized services are reduced in amount 
 39.27  from those requested by the home care provider.  
 39.28     (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
 39.29  the commissioner's designee shall determine the medical 
 39.30  necessity of home care services, the level of caregiver 
 39.31  according to subdivision 2, and the institutional comparison 
 39.32  according to this subdivision, the cost-effectiveness of 
 39.33  services, and the amount, scope, and duration of home care 
 39.34  services reimbursable by medical assistance, based on the 
 39.35  assessment, primary payer coverage determination information as 
 39.36  required, the service plan, the recipient's age, the cost of 
 40.1   services, the recipient's medical condition, and diagnosis or 
 40.2   disability.  The commissioner may publish additional criteria 
 40.3   for determining medical necessity according to section 256B.04. 
 40.4      (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
 40.5   The agency nurse, the independently enrolled private duty nurse, 
 40.6   or county public health nurse may request a temporary 
 40.7   authorization for home care services by telephone.  The 
 40.8   commissioner may approve a temporary level of home care services 
 40.9   based on the assessment, and service or care plan information, 
 40.10  and primary payer coverage determination information as required.
 40.11  Authorization for a temporary level of home care services 
 40.12  including nurse supervision is limited to the time specified by 
 40.13  the commissioner, but shall not exceed 45 days, unless extended 
 40.14  because the county public health nurse has not completed the 
 40.15  required assessment and service plan, or the commissioner's 
 40.16  determination has not been made.  The level of services 
 40.17  authorized under this provision shall have no bearing on a 
 40.18  future prior authorization. 
 40.19     (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
 40.20  Home care services provided in an adult or child foster care 
 40.21  setting must receive prior authorization by the department 
 40.22  according to the limits established in paragraph (a). 
 40.23     The commissioner may not authorize: 
 40.24     (1) home care services that are the responsibility of the 
 40.25  foster care provider under the terms of the foster care 
 40.26  placement agreement and administrative rules; 
 40.27     (2) personal care services when the foster care license 
 40.28  holder is also the personal care provider or personal care 
 40.29  assistant unless the recipient can direct the recipient's own 
 40.30  care, or case management is provided as required in section 
 40.31  256B.0625, subdivision 19a; 
 40.32     (3) personal care services when the responsible party is an 
 40.33  employee of, or under contract with, or has any direct or 
 40.34  indirect financial relationship with the personal care provider 
 40.35  or personal care assistant, unless case management is provided 
 40.36  as required in section 256B.0625, subdivision 19a; or 
 41.1      (4) personal care assistant and private duty nursing 
 41.2   services when the number of foster care residents is greater 
 41.3   than four unless the county responsible for the recipient's 
 41.4   foster placement made the placement prior to April 1, 1992, 
 41.5   requests that personal care assistant and private duty nursing 
 41.6   services be provided, and case management is provided as 
 41.7   required in section 256B.0625, subdivision 19a. 
 41.8      Sec. 22.  Minnesota Statutes 2000, section 256B.0627, 
 41.9   subdivision 7, is amended to read: 
 41.10     Subd. 7.  [NONCOVERED HOME CARE SERVICES.] The following 
 41.11  home care services are not eligible for payment under medical 
 41.12  assistance:  
 41.13     (1) skilled nurse visits for the sole purpose of 
 41.14  supervision of the home health aide; 
 41.15     (2) a skilled nursing visit: 
 41.16     (i) only for the purpose of monitoring medication 
 41.17  compliance with an established medication program for a 
 41.18  recipient; or 
 41.19     (ii) to administer or assist with medication 
 41.20  administration, including injections, prefilling syringes for 
 41.21  injections, or oral medication set-up of an adult recipient, 
 41.22  when as determined and documented by the registered nurse, the 
 41.23  need can be met by an available pharmacy or the recipient is 
 41.24  physically and mentally able to self-administer or prefill a 
 41.25  medication; 
 41.26     (3) home care services to a recipient who is eligible for 
 41.27  covered services including hospice, if elected by the recipient, 
 41.28  under the Medicare program or any other insurance held by the 
 41.29  recipient; 
 41.30     (4) services to other members of the recipient's household; 
 41.31     (5) a visit made by a skilled nurse solely to train other 
 41.32  home health agency workers; 
 41.33     (6) any home care service included in the daily rate of the 
 41.34  community-based residential facility where the recipient is 
 41.35  residing; 
 41.36     (7) nursing and rehabilitation therapy services that are 
 42.1   reasonably accessible to a recipient outside the recipient's 
 42.2   place of residence, excluding the assessment, counseling and 
 42.3   education, and personal assistant care; 
 42.4      (8) any home health agency service, excluding personal care 
 42.5   assistant services and private duty nursing services, which are 
 42.6   performed in a place other than the recipient's residence; and 
 42.7      (9) Medicare evaluation or administrative nursing visits on 
 42.8   dual-eligible recipients that do not qualify for Medicare visit 
 42.9   billing. 
 42.10     Sec. 23.  Minnesota Statutes 2000, section 256B.0627, 
 42.11  subdivision 8, is amended to read: 
 42.12     Subd. 8.  [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 
 42.13  Medical assistance payments for shared personal care assistance 
 42.14  services shall be limited according to this subdivision. 
 42.15     (b) Recipients of personal care assistant services may 
 42.16  share staff and the commissioner shall provide a rate system for 
 42.17  shared personal care assistant services.  For two persons 
 42.18  sharing services, the rate paid to a provider shall not exceed 
 42.19  1-1/2 times the rate paid for serving a single individual, and 
 42.20  for three persons sharing services, the rate paid to a provider 
 42.21  shall not exceed twice the rate paid for serving a single 
 42.22  individual.  These rates apply only to situations in which all 
 42.23  recipients were present and received shared services on the date 
 42.24  for which the service is billed.  No more than three persons may 
 42.25  receive shared services from a personal care assistant in a 
 42.26  single setting. 
 42.27     (c) Shared service is the provision of personal care 
 42.28  services by a personal care assistant to two or three recipients 
 42.29  at the same time and in the same setting.  For the purposes of 
 42.30  this subdivision, "setting" means: 
 42.31     (1) the home or foster care home of one of the individual 
 42.32  recipients; or 
 42.33     (2) a child care program in which all recipients served by 
 42.34  one personal care assistant are participating, which is licensed 
 42.35  under chapter 245A or operated by a local school district or 
 42.36  private school; or 
 43.1      (3) outside the home or foster care home of one of the 
 43.2   recipients when normal life activities take the recipients 
 43.3   outside the home.  
 43.4      The provisions of this subdivision do not apply when a 
 43.5   personal care assistant is caring for multiple recipients in 
 43.6   more than one setting. 
 43.7      (d) The recipient or the recipient's responsible party, in 
 43.8   conjunction with the county public health nurse, shall determine:
 43.9      (1) whether shared personal care assistant services is an 
 43.10  appropriate option based on the individual needs and preferences 
 43.11  of the recipient; and 
 43.12     (2) the amount of shared services allocated as part of the 
 43.13  overall authorization of personal care services. 
 43.14     The recipient or the responsible party, in conjunction with 
 43.15  the supervising qualified professional, if a qualified 
 43.16  professional is requested by any one of the recipients or 
 43.17  responsible parties, shall arrange the setting and grouping of 
 43.18  shared services based on the individual needs and preferences of 
 43.19  the recipients.  Decisions on the selection of recipients to 
 43.20  share services must be based on the ages of the recipients, 
 43.21  compatibility, and coordination of their care needs. 
 43.22     (e) The following items must be considered by the recipient 
 43.23  or the responsible party and the supervising qualified 
 43.24  professional, if a qualified professional has been requested by 
 43.25  any one of the recipients or responsible parties, and documented 
 43.26  in the recipient's health service record: 
 43.27     (1) the additional qualifications needed by the personal 
 43.28  care assistant to provide care to several recipients in the same 
 43.29  setting; 
 43.30     (2) the additional training and supervision needed by the 
 43.31  personal care assistant to ensure that the needs of the 
 43.32  recipient are met appropriately and safely.  The provider must 
 43.33  provide on-site supervision by a qualified professional within 
 43.34  the first 14 days of shared services, and monthly thereafter, if 
 43.35  supervision by a qualified provider has been requested by any 
 43.36  one of the recipients or responsible parties; 
 44.1      (3) the setting in which the shared services will be 
 44.2   provided; 
 44.3      (4) the ongoing monitoring and evaluation of the 
 44.4   effectiveness and appropriateness of the service and process 
 44.5   used to make changes in service or setting; and 
 44.6      (5) a contingency plan which accounts for absence of the 
 44.7   recipient in a shared services setting due to illness or other 
 44.8   circumstances and staffing contingencies. 
 44.9      (f) The provider must offer the recipient or the 
 44.10  responsible party the option of shared or one-on-one personal 
 44.11  care assistant services.  The recipient or the responsible party 
 44.12  can withdraw from participating in a shared services arrangement 
 44.13  at any time. 
 44.14     (g) In addition to documentation requirements under 
 44.15  Minnesota Rules, part 9505.2175, a personal care provider must 
 44.16  meet documentation requirements for shared personal care 
 44.17  assistant services and must document the following in the health 
 44.18  service record for each individual recipient sharing services: 
 44.19     (1) permission by the recipient or the recipient's 
 44.20  responsible party, if any, for the maximum number of shared 
 44.21  services hours per week chosen by the recipient; 
 44.22     (2) permission by the recipient or the recipient's 
 44.23  responsible party, if any, for personal care assistant services 
 44.24  provided outside the recipient's residence; 
 44.25     (3) permission by the recipient or the recipient's 
 44.26  responsible party, if any, for others to receive shared services 
 44.27  in the recipient's residence; 
 44.28     (4) revocation by the recipient or the recipient's 
 44.29  responsible party, if any, of the shared service authorization, 
 44.30  or the shared service to be provided to others in the 
 44.31  recipient's residence, or the shared service to be provided 
 44.32  outside the recipient's residence; 
 44.33     (5) supervision of the shared personal care assistant 
 44.34  services by the qualified professional, if a qualified 
 44.35  professional is requested by one of the recipients or 
 44.36  responsible parties, including the date, time of day, number of 
 45.1   hours spent supervising the provision of shared services, 
 45.2   whether the supervision was face-to-face or another method of 
 45.3   supervision, changes in the recipient's condition, shared 
 45.4   services scheduling issues and recommendations; 
 45.5      (6) documentation by the qualified professional, if a 
 45.6   qualified professional is requested by one of the recipients or 
 45.7   responsible parties, of telephone calls or other discussions 
 45.8   with the personal care assistant regarding services being 
 45.9   provided to the recipient who has requested the supervision; and 
 45.10     (7) daily documentation of the shared services provided by 
 45.11  each identified personal care assistant including: 
 45.12     (i) the names of each recipient receiving shared services 
 45.13  together; 
 45.14     (ii) the setting for the shared services, including the 
 45.15  starting and ending times that the recipient received shared 
 45.16  services; and 
 45.17     (iii) notes by the personal care assistant regarding 
 45.18  changes in the recipient's condition, problems that may arise 
 45.19  from the sharing of services, scheduling issues, care issues, 
 45.20  and other notes as required by the qualified professional, if a 
 45.21  qualified professional is requested by one of the recipients or 
 45.22  responsible parties. 
 45.23     (h) Unless otherwise provided in this subdivision, all 
 45.24  other statutory and regulatory provisions relating to personal 
 45.25  care services apply to shared services. 
 45.26     (i) In the event that supervision by a qualified 
 45.27  professional has been requested by one or more recipients, but 
 45.28  not by all of the recipients, the supervision duties of the 
 45.29  qualified professional shall be limited to only those recipients 
 45.30  who have requested the supervision. 
 45.31     Nothing in this subdivision shall be construed to reduce 
 45.32  the total number of hours authorized for an individual recipient.
 45.33     Sec. 24.  Minnesota Statutes 2000, section 256B.0627, 
 45.34  subdivision 10, is amended to read: 
 45.35     Subd. 10.  [FISCAL AGENT INTERMEDIARY OPTION AVAILABLE FOR 
 45.36  PERSONAL CARE ASSISTANT SERVICES.] (a) "Fiscal agent option" is 
 46.1   an option that allows the recipient to: 
 46.2      (1) use a fiscal agent instead of a personal care provider 
 46.3   organization; 
 46.4      (2) supervise the personal care assistant; and 
 46.5      (3) use a consulting professional. 
 46.6      The commissioner may allow a recipient of personal care 
 46.7   assistant services to use a fiscal agent intermediary to assist 
 46.8   the recipient in paying and accounting for medically necessary 
 46.9   covered personal care assistant services authorized in 
 46.10  subdivision 4 and within the payment parameters of subdivision 
 46.11  5.  Unless otherwise provided in this subdivision, all other 
 46.12  statutory and regulatory provisions relating to personal care 
 46.13  services apply to a recipient using the fiscal agent 
 46.14  intermediary option. 
 46.15     (b) The recipient or responsible party shall: 
 46.16     (1) hire, and terminate the personal care assistant and 
 46.17  consulting professional, with the fiscal agent recruit, hire, 
 46.18  and terminate a qualified professional, if a qualified 
 46.19  professional is requested by the recipient or responsible party; 
 46.20     (2) recruit the personal care assistant and consulting 
 46.21  professional and orient and train the personal care assistant in 
 46.22  areas that do not require professional delegation as determined 
 46.23  by the county public health nurse verify and document the 
 46.24  credentials of the qualified professional, if a qualified 
 46.25  professional is requested by the recipient or responsible party; 
 46.26     (3) supervise and evaluate the personal care assistant in 
 46.27  areas that do not require professional delegation as determined 
 46.28  in the assessment; 
 46.29     (4) cooperate with a consulting develop a plan of care 
 46.30  based on physician orders and public health nurse assessment 
 46.31  with the assistance of a qualified professional and implement 
 46.32  recommendations pertaining to the health and safety of the 
 46.33  recipient, if a qualified professional is requested by the 
 46.34  recipient or responsible party, that addresses the health and 
 46.35  safety of the recipient; 
 46.36     (5) hire a qualified professional to train and supervise 
 47.1   the performance of delegated tasks done by (4) recruit, hire, 
 47.2   and terminate the personal care assistant; 
 47.3      (6) monitor services and verify in writing the hours worked 
 47.4   by the personal care assistant and the consulting (5) orient and 
 47.5   train the personal care assistant with assistance as needed from 
 47.6   the qualified professional; 
 47.7      (7) develop and revise a care plan with assistance from a 
 47.8   consulting (6) supervise and evaluate the personal care 
 47.9   assistant with assistance as needed from the recipient's 
 47.10  physician or the qualified professional; 
 47.11     (8) verify and document the credentials of the consulting 
 47.12  (7) monitor and verify in writing and report to the fiscal 
 47.13  intermediary the number of hours worked by the personal care 
 47.14  assistant and the qualified professional; and 
 47.15     (9) (8) enter into a written agreement, as specified in 
 47.16  paragraph (f). 
 47.17     (c) The duties of the fiscal agent intermediary shall be to:
 47.18     (1) bill the medical assistance program for personal care 
 47.19  assistant and consulting qualified professional services; 
 47.20     (2) request and secure background checks on personal care 
 47.21  assistants and consulting qualified professionals according to 
 47.22  section 245A.04; 
 47.23     (3) pay the personal care assistant and consulting 
 47.24  qualified professional based on actual hours of services 
 47.25  provided; 
 47.26     (4) withhold and pay all applicable federal and state 
 47.27  taxes; 
 47.28     (5) verify and document keep records of hours worked by the 
 47.29  personal care assistant and consulting qualified professional; 
 47.30     (6) make the arrangements and pay unemployment insurance, 
 47.31  taxes, workers' compensation, liability insurance, and other 
 47.32  benefits, if any; 
 47.33     (7) enroll in the medical assistance program as a fiscal 
 47.34  agent intermediary; and 
 47.35     (8) enter into a written agreement as specified in 
 47.36  paragraph (f) before services are provided. 
 48.1      (d) The fiscal agent intermediary: 
 48.2      (1) may not be related to the recipient, consulting 
 48.3   qualified professional, or the personal care assistant; 
 48.4      (2) must ensure arm's length transactions with the 
 48.5   recipient and personal care assistant; and 
 48.6      (3) shall be considered a joint employer of the personal 
 48.7   care assistant and consulting qualified professional to the 
 48.8   extent specified in this section. 
 48.9      The fiscal agent intermediary or owners of the entity that 
 48.10  provides fiscal agent intermediary services under this 
 48.11  subdivision must pass a criminal background check as required in 
 48.12  section 256B.0627, subdivision 1, paragraph (e). 
 48.13     (e) If the recipient or responsible party requests a 
 48.14  qualified professional, the consulting qualified professional 
 48.15  providing assistance to the recipient shall meet the 
 48.16  qualifications specified in section 256B.0625, subdivision 19c.  
 48.17  The consulting qualified professional shall assist the recipient 
 48.18  in developing and revising a plan to meet the 
 48.19  recipient's assessed needs, and supervise the performance of 
 48.20  delegated tasks, as determined by the public health nurse as 
 48.21  assessed by the public health nurse.  In performing this 
 48.22  function, the consulting qualified professional must visit the 
 48.23  recipient in the recipient's home at least once annually.  
 48.24  The consulting qualified professional must report to the local 
 48.25  county public health nurse concerns relating to the health and 
 48.26  safety of the recipient, and any suspected abuse, neglect, or 
 48.27  financial exploitation of the recipient to the appropriate 
 48.28  authorities.  
 48.29     (f) The fiscal agent intermediary, recipient or responsible 
 48.30  party, personal care assistant, and consulting qualified 
 48.31  professional shall enter into a written agreement before 
 48.32  services are started.  The agreement shall include: 
 48.33     (1) the duties of the recipient, qualified professional, 
 48.34  personal care assistant, and fiscal agent based on paragraphs 
 48.35  (a) to (e); 
 48.36     (2) the salary and benefits for the personal care assistant 
 49.1   and those providing professional consultation the qualified 
 49.2   professional; 
 49.3      (3) the administrative fee of the fiscal agent intermediary 
 49.4   and services paid for with that fee, including background check 
 49.5   fees; 
 49.6      (4) procedures to respond to billing or payment complaints; 
 49.7   and 
 49.8      (5) procedures for hiring and terminating the personal care 
 49.9   assistant and those providing professional consultation the 
 49.10  qualified professional. 
 49.11     (g) The rates paid for personal care assistant services, 
 49.12  qualified professional assistance services, and fiscal agency 
 49.13  intermediary services under this subdivision shall be the same 
 49.14  rates paid for personal care services and qualified professional 
 49.15  services under subdivision 2 respectively.  Except for the 
 49.16  administrative fee of the fiscal agent intermediary specified in 
 49.17  paragraph (f), the remainder of the rates paid to the 
 49.18  fiscal agent intermediary must be used to pay for the salary and 
 49.19  benefits for the personal care assistant or those providing 
 49.20  professional consultation the qualified professional. 
 49.21     (h) As part of the assessment defined in subdivision 1, the 
 49.22  following conditions must be met to use or continue use of a 
 49.23  fiscal agent intermediary: 
 49.24     (1) the recipient must be able to direct the recipient's 
 49.25  own care, or the responsible party for the recipient must be 
 49.26  readily available to direct the care of the personal care 
 49.27  assistant; 
 49.28     (2) the recipient or responsible party must be 
 49.29  knowledgeable of the health care needs of the recipient and be 
 49.30  able to effectively communicate those needs; 
 49.31     (3) a face-to-face assessment must be conducted by the 
 49.32  local county public health nurse at least annually, or when 
 49.33  there is a significant change in the recipient's condition or 
 49.34  change in the need for personal care assistant services.  The 
 49.35  county public health nurse shall determine the services that 
 49.36  require professional delegation, if any, and the amount and 
 50.1   frequency of related supervision; 
 50.2      (4) the recipient cannot select the shared services option 
 50.3   as specified in subdivision 8; and 
 50.4      (5) parties must be in compliance with the written 
 50.5   agreement specified in paragraph (f). 
 50.6      (i) The commissioner shall deny, revoke, or suspend the 
 50.7   authorization to use the fiscal agent intermediary option if: 
 50.8      (1) it has been determined by the consulting qualified 
 50.9   professional or local county public health nurse that the use of 
 50.10  this option jeopardizes the recipient's health and safety; 
 50.11     (2) the parties have failed to comply with the written 
 50.12  agreement specified in paragraph (f); or 
 50.13     (3) the use of the option has led to abusive or fraudulent 
 50.14  billing for personal care assistant services.  
 50.15     The recipient or responsible party may appeal the 
 50.16  commissioner's action according to section 256.045.  The denial, 
 50.17  revocation, or suspension to use the fiscal agent intermediary 
 50.18  option shall not affect the recipient's authorized level of 
 50.19  personal care assistant services as determined in subdivision 5. 
 50.20     Sec. 25.  Minnesota Statutes 2000, section 256B.0627, 
 50.21  subdivision 11, is amended to read: 
 50.22     Subd. 11.  [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 
 50.23  Medical assistance payments for shared private duty nursing 
 50.24  services by a private duty nurse shall be limited according to 
 50.25  this subdivision.  For the purposes of this section, "private 
 50.26  duty nursing agency" means an agency licensed under chapter 144A 
 50.27  to provide private duty nursing services. 
 50.28     (b) Recipients of private duty nursing services may share 
 50.29  nursing staff and the commissioner shall provide a rate 
 50.30  methodology for shared private duty nursing.  For two persons 
 50.31  sharing nursing care, the rate paid to a provider shall not 
 50.32  exceed 1.5 times the nonwaivered regular private duty nursing 
 50.33  rates paid for serving a single individual who is not ventilator 
 50.34  dependent, by a registered nurse or licensed practical nurse.  
 50.35  These rates apply only to situations in which both recipients 
 50.36  are present and receive shared private duty nursing care on the 
 51.1   date for which the service is billed.  No more than two persons 
 51.2   may receive shared private duty nursing services from a private 
 51.3   duty nurse in a single setting. 
 51.4      (c) Shared private duty nursing care is the provision of 
 51.5   nursing services by a private duty nurse to two recipients at 
 51.6   the same time and in the same setting.  For the purposes of this 
 51.7   subdivision, "setting" means: 
 51.8      (1) the home or foster care home of one of the individual 
 51.9   recipients; or 
 51.10     (2) a child care program licensed under chapter 245A or 
 51.11  operated by a local school district or private school; or 
 51.12     (3) an adult day care service licensed under chapter 245A; 
 51.13  or 
 51.14     (4) outside the home or foster care home of one of the 
 51.15  recipients when normal life activities take the recipients 
 51.16  outside the home.  
 51.17     This subdivision does not apply when a private duty nurse 
 51.18  is caring for multiple recipients in more than one setting. 
 51.19     (d) The recipient or the recipient's legal representative, 
 51.20  and the recipient's physician, in conjunction with the home 
 51.21  health care agency, shall determine: 
 51.22     (1) whether shared private duty nursing care is an 
 51.23  appropriate option based on the individual needs and preferences 
 51.24  of the recipient; and 
 51.25     (2) the amount of shared private duty nursing services 
 51.26  authorized as part of the overall authorization of nursing 
 51.27  services. 
 51.28     (e) The recipient or the recipient's legal representative, 
 51.29  in conjunction with the private duty nursing agency, shall 
 51.30  approve the setting, grouping, and arrangement of shared private 
 51.31  duty nursing care based on the individual needs and preferences 
 51.32  of the recipients.  Decisions on the selection of recipients to 
 51.33  share services must be based on the ages of the recipients, 
 51.34  compatibility, and coordination of their care needs. 
 51.35     (f) The following items must be considered by the recipient 
 51.36  or the recipient's legal representative and the private duty 
 52.1   nursing agency, and documented in the recipient's health service 
 52.2   record: 
 52.3      (1) the additional training needed by the private duty 
 52.4   nurse to provide care to two recipients in the same setting and 
 52.5   to ensure that the needs of the recipients are met appropriately 
 52.6   and safely; 
 52.7      (2) the setting in which the shared private duty nursing 
 52.8   care will be provided; 
 52.9      (3) the ongoing monitoring and evaluation of the 
 52.10  effectiveness and appropriateness of the service and process 
 52.11  used to make changes in service or setting; 
 52.12     (4) a contingency plan which accounts for absence of the 
 52.13  recipient in a shared private duty nursing setting due to 
 52.14  illness or other circumstances; 
 52.15     (5) staffing backup contingencies in the event of employee 
 52.16  illness or absence; and 
 52.17     (6) arrangements for additional assistance to respond to 
 52.18  urgent or emergency care needs of the recipients. 
 52.19     (g) The provider must offer the recipient or responsible 
 52.20  party the option of shared or one-on-one private duty nursing 
 52.21  services.  The recipient or responsible party can withdraw from 
 52.22  participating in a shared service arrangement at any time. 
 52.23     (h) The private duty nursing agency must document the 
 52.24  following in the health service record for each individual 
 52.25  recipient sharing private duty nursing care: 
 52.26     (1) permission by the recipient or the recipient's legal 
 52.27  representative for the maximum number of shared nursing care 
 52.28  hours per week chosen by the recipient; 
 52.29     (2) permission by the recipient or the recipient's legal 
 52.30  representative for shared private duty nursing services provided 
 52.31  outside the recipient's residence; 
 52.32     (3) permission by the recipient or the recipient's legal 
 52.33  representative for others to receive shared private duty nursing 
 52.34  services in the recipient's residence; 
 52.35     (4) revocation by the recipient or the recipient's legal 
 52.36  representative of the shared private duty nursing care 
 53.1   authorization, or the shared care to be provided to others in 
 53.2   the recipient's residence, or the shared private duty nursing 
 53.3   services to be provided outside the recipient's residence; and 
 53.4      (5) daily documentation of the shared private duty nursing 
 53.5   services provided by each identified private duty nurse, 
 53.6   including: 
 53.7      (i) the names of each recipient receiving shared private 
 53.8   duty nursing services together; 
 53.9      (ii) the setting for the shared services, including the 
 53.10  starting and ending times that the recipient received shared 
 53.11  private duty nursing care; and 
 53.12     (iii) notes by the private duty nurse regarding changes in 
 53.13  the recipient's condition, problems that may arise from the 
 53.14  sharing of private duty nursing services, and scheduling and 
 53.15  care issues. 
 53.16     (i) Unless otherwise provided in this subdivision, all 
 53.17  other statutory and regulatory provisions relating to private 
 53.18  duty nursing services apply to shared private duty nursing 
 53.19  services. 
 53.20     Nothing in this subdivision shall be construed to reduce 
 53.21  the total number of private duty nursing hours authorized for an 
 53.22  individual recipient under subdivision 5. 
 53.23     Sec. 26.  Minnesota Statutes 2000, section 256B.0627, is 
 53.24  amended by adding a subdivision to read: 
 53.25     Subd. 13.  [CONSUMER-DIRECTED HOME CARE DEMONSTRATION 
 53.26  PROJECT.] (a) The commissioner of human services after receiving 
 53.27  federal waiver authority shall implement a consumer-directed 
 53.28  home care demonstration project.  The consumer-directed home 
 53.29  care demonstration project must demonstrate and evaluate the 
 53.30  outcomes of a consumer-directed service delivery alternative to 
 53.31  improve access, increase consumer control and accountability 
 53.32  over available resources, and enable the use of supports that 
 53.33  are more individualized and cost-effective for eligible medical 
 53.34  assistance recipients receiving certain medical assistance home 
 53.35  care services.  The consumer-directed home care demonstration 
 53.36  project will be administered locally by county agencies, tribal 
 54.1   governments, or administrative entities under contract with the 
 54.2   state in regions where counties choose not to provide this 
 54.3   service. 
 54.4      (b) Grant awards for persons who have been receiving 
 54.5   medical assistance covered personal care, home health aide, or 
 54.6   private duty nursing services for a period of 12 consecutive 
 54.7   months or more prior to enrollment in the consumer-directed home 
 54.8   care demonstration project will be established on a case-by-case 
 54.9   basis using historical service expenditure data.  An average 
 54.10  monthly expenditure for each continuing enrollee will be 
 54.11  calculated based on historical expenditures made on behalf of 
 54.12  the enrollee for personal care, home health aide, or private 
 54.13  duty nursing services during the 12 month period directly prior 
 54.14  to enrollment in the project.  The grant award will equal 90 
 54.15  percent of the average monthly expenditure. 
 54.16     (c) Grant awards for project enrollees who have been 
 54.17  receiving medical assistance covered personal care, home health 
 54.18  aide, or private duty nursing services for a period of less than 
 54.19  12 consecutive months prior to project enrollment will be 
 54.20  calculated on a case-by-case basis using the service 
 54.21  authorization in place at the time of enrollment.  The total 
 54.22  number of units of personal care, home health aide, or private 
 54.23  duty nursing services the enrollee has been authorized to 
 54.24  receive will be converted to the total cost of the authorized 
 54.25  services in a given month using the statewide average service 
 54.26  payment rates.  To determine an estimated monthly expenditure, 
 54.27  the total authorized monthly personal care, home health aide or 
 54.28  private duty nursing service costs will be reduced by a 
 54.29  percentage rate equivalent to the difference between the 
 54.30  statewide average service authorization and the statewide 
 54.31  average utilization rate for each of the services by medical 
 54.32  assistance eligibles during the most recent fiscal year for 
 54.33  which 12 months of data is available.  The grant award will 
 54.34  equal 90 percent of the estimated monthly expenditure. 
 54.35     Sec. 27.  Minnesota Statutes 2000, section 256B.0627, is 
 54.36  amended by adding a subdivision to read: 
 55.1      Subd. 14.  [TELEHOMECARE; SKILLED NURSE VISITS.] Medical 
 55.2   assistance covers skilled nurse visits according to section 
 55.3   256B.0625, subdivision 6a, provided via telehomecare, for 
 55.4   services which do not require hands-on care between the home 
 55.5   care nurse and recipient.  The provision of telehomecare must be 
 55.6   made via live, two-way interactive audiovisual technology and 
 55.7   may be augmented by utilizing store-and-forward technologies.  
 55.8   Store-and-forward technology includes telehomecare services that 
 55.9   do not occur in real time via synchronous transmissions, and 
 55.10  that do not require a face-to-face encounter with the recipient 
 55.11  for all or any part of any such telehomecare visit.  A 
 55.12  communication between the home care nurse and recipient that 
 55.13  consists solely of a telephone conversation, facsimile, 
 55.14  electronic mail, or a consultation between two health care 
 55.15  practitioners, is not to be considered a telehomecare visit.  
 55.16  Multiple daily skilled nurse visits provided via telehomecare 
 55.17  are allowed.  Coverage of telehomecare is limited to two visits 
 55.18  per day.  All skilled nurse visits provided via telehomecare 
 55.19  must be prior authorized by the commissioner or the 
 55.20  commissioner's designee and will be covered at the same 
 55.21  allowable rate as skilled nurse visits provided in-person. 
 55.22     Sec. 28.  Minnesota Statutes 2000, section 256B.0627, is 
 55.23  amended by adding a subdivision to read: 
 55.24     Subd. 15.  [THERAPIES THROUGH HOME HEALTH AGENCIES.] (a)  
 55.25  [PHYSICAL THERAPY.] Medical assistance covers physical therapy 
 55.26  and related services, including specialized maintenance 
 55.27  therapy.  Services provided by a physical therapy assistant 
 55.28  shall be reimbursed at the same rate as services performed by a 
 55.29  physical therapist when the services of the physical therapy 
 55.30  assistant are provided under the direction of a physical 
 55.31  therapist who is on the premises.  Services provided by a 
 55.32  physical therapy assistant that are provided under the direction 
 55.33  of a physical therapist who is not on the premises shall be 
 55.34  reimbursed at 65 percent of the physical therapist rate.  
 55.35  Direction of the physical therapy assistant must be provided by 
 55.36  the physical therapist as described in Minnesota Rules, part 
 56.1   9505.0390, subpart 1, item B.  The physical therapist and 
 56.2   physical therapist assistant may not both bill for services 
 56.3   provided to a recipient on the same day. 
 56.4      (b)  [OCCUPATIONAL THERAPY.] Medical assistance covers 
 56.5   occupational therapy and related services, including specialized 
 56.6   maintenance therapy.  Services provided by an occupational 
 56.7   therapy assistant shall be reimbursed at the same rate as 
 56.8   services performed by an occupational therapist when the 
 56.9   services of the occupational therapy assistant are provided 
 56.10  under the direction of the occupational therapist who is on the 
 56.11  premises.  Services provided by an occupational therapy 
 56.12  assistant under the direction of an occupational therapist who 
 56.13  is not on the premises shall be reimbursed at 65 percent of the 
 56.14  occupational therapist rate.  Direction of the occupational 
 56.15  therapy assistant must be provided by the occupational therapist 
 56.16  as described in Minnesota Rules, part 9505.0390, subpart 1, item 
 56.17  B.  The occupational therapist and occupational therapist 
 56.18  assistant may not both bill for services provided to a recipient 
 56.19  on the same day. 
 56.20     Sec. 29.  Minnesota Statutes 2000, section 256B.0627, is 
 56.21  amended by adding a subdivision to read: 
 56.22     Subd. 16.  [HARDSHIP CRITERIA; PRIVATE DUTY NURSING.] (a) 
 56.23  Payment is allowed for extraordinary services that require 
 56.24  specialized nursing skills and are provided by parents of minor 
 56.25  children, spouses, and legal guardians who are providing private 
 56.26  duty nursing care, when the provision of these services is not 
 56.27  legally required of the parents, spouses, or legal guardians, to 
 56.28  a recipient under the state plan home care or under a home and 
 56.29  community waiver in order to prevent hospitalization of the 
 56.30  recipient if one of the following hardship criteria are met: 
 56.31     (1) the parent, spouse, or legal guardian resigns from a 
 56.32  part-time or full-time job to provide nursing care for the 
 56.33  recipient; or 
 56.34     (2) the parent, spouse, or legal guardian goes from a 
 56.35  full-time to a part-time job with less compensation to provide 
 56.36  nursing care for the recipient; or 
 57.1      (3) the parent, spouse, or legal guardian takes a leave of 
 57.2   absence without pay to provide nursing care for the recipient; 
 57.3   or 
 57.4      (4) because of labor conditions, special language needs, or 
 57.5   intermittent hours of care needed, the parent, spouse, or legal 
 57.6   guardian is needed in order to provide adequate private duty 
 57.7   nursing services to meet the medical needs of the recipient. 
 57.8      (b) Private duty nursing may be provided by a parent, 
 57.9   spouse, or legal guardian who is a nurse licensed in Minnesota.  
 57.10  Private duty nursing services provided by a parent, spouse, or 
 57.11  legal guardian cannot be used in lieu of nursing services 
 57.12  covered and available under liable third-party payors including 
 57.13  Medicare.  The private duty nursing provided by a parent, 
 57.14  spouse, or legal guardian must be included in the plan of care.  
 57.15  Authorized skilled nursing services provided by the parent, 
 57.16  spouse, or legal guardian may not exceed 50 percent of the total 
 57.17  approved nursing hours, or eight hours per day, whichever is 
 57.18  less, up to a maximum of 40 hours per week.  Nothing in this 
 57.19  subdivision precludes the parent's, spouse's, or legal 
 57.20  guardian's obligation of assuming the nonreimbursed family 
 57.21  responsibilities of emergency backup caregiver and primary 
 57.22  caregiver. 
 57.23     (c) A parent or a spouse may not be paid to provide private 
 57.24  duty nursing care if the parent or spouse fails to pass a 
 57.25  criminal background check according to section 245A.04, or if it 
 57.26  has been determined by the home health agency, the case manager, 
 57.27  or the physician that the private duty nursing care provided by 
 57.28  the parent, spouse, or legal guardian is unsafe. 
 57.29     Sec. 30.  Minnesota Statutes 2000, section 256B.0627, is 
 57.30  amended by adding a subdivision to read: 
 57.31     Subd. 17.  [QUALITY ASSURANCE PLAN FOR PERSONAL CARE 
 57.32  ASSISTANT SERVICES.] The commissioner shall establish a quality 
 57.33  assurance plan for personal care services that includes: 
 57.34     (1) performance-based provider agreements; 
 57.35     (2) meaningful consumer input, which may include consumer 
 57.36  surveys, that measure the extent to which participants receive 
 58.1   the services and supports described in the individual plan and 
 58.2   participant satisfaction with such services and supports; 
 58.3      (3) ongoing monitoring of the health and well-being of 
 58.4   consumers; and 
 58.5      (4) an ongoing public process for development, 
 58.6   implementation, and review of the quality assurance plan.  
 58.7      Sec. 31.  Minnesota Statutes 2000, section 256B.0911, is 
 58.8   amended by adding a subdivision to read: 
 58.9      Subd. 4a.  [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 
 58.10  YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 
 58.11  ensure that individuals with disabilities or chronic illness are 
 58.12  served in the most integrated setting appropriate to their needs 
 58.13  and have the necessary information to make informed choices 
 58.14  about home and community-based service options. 
 58.15     (b) Individuals under 65 years of age who are admitted to a 
 58.16  nursing facility from a hospital must be screened prior to 
 58.17  admission as outlined in subdivision 4. 
 58.18     (c) Individuals under 65 years of age who are admitted to 
 58.19  nursing facilities with only a telephone screening must receive 
 58.20  a face-to-face assessment from the long-term care consultation 
 58.21  team member of the county in which the facility is located or 
 58.22  from the recipient's county case manager within 20 working days 
 58.23  of admission. 
 58.24     (d) At the face-to-face assessment, the long-term care 
 58.25  consultation team member or county case manager must perform the 
 58.26  activities required under subdivision 3. 
 58.27     (e) For individuals under 21 years of age, the screening or 
 58.28  assessment which recommends nursing facility admission must be 
 58.29  approved by the commissioner before the individual is admitted 
 58.30  to the nursing facility. 
 58.31     (f) In the event that an individual under 65 years of age 
 58.32  is admitted to a nursing facility on an emergency basis, the 
 58.33  county must be notified of the admission on the next working 
 58.34  day, and a face-to-face assessment as described in paragraph (c) 
 58.35  must be conducted within 20 working days of admission. 
 58.36     (g) At the face-to-face assessment, the long-term care 
 59.1   consultation team member or the case manager must present 
 59.2   information about home and community-based options so the 
 59.3   individual can make informed choices.  If the individual chooses 
 59.4   home and community-based services, the long-term care 
 59.5   consultation team member or case manager must initiate the 
 59.6   development of a written relocation plan within 30 working days 
 59.7   of the visit.  The plan shall ensure a smooth transition to the 
 59.8   individual's home and community. 
 59.9      (h) An individual under 65 years of age residing in a 
 59.10  nursing facility shall receive a face-to-face assessment at 
 59.11  least every 12 months to review the person's service choices and 
 59.12  available alternatives unless the individual indicates, in 
 59.13  writing, that annual visits are not desired.  In this case, the 
 59.14  individual must receive a face-to-face assessment at least once 
 59.15  every 36 months for the same purposes. 
 59.16     (i) Notwithstanding the provisions of subdivision 6, the 
 59.17  commissioner may pay county agencies directly for face-to-face 
 59.18  assessments for individuals who are eligible for medical 
 59.19  assistance, under 65 years of age, and being considered for 
 59.20  placement or residing in a nursing facility. 
 59.21     Sec. 32.  Minnesota Statutes 2000, section 256B.093, 
 59.22  subdivision 3, is amended to read: 
 59.23     Subd. 3.  [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 
 59.24  department shall fund administrative case management under this 
 59.25  subdivision using medical assistance administrative funds.  The 
 59.26  traumatic brain injury program duties include: 
 59.27     (1) recommending to the commissioner in consultation with 
 59.28  the medical review agent according to Minnesota Rules, parts 
 59.29  9505.0500 to 9505.0540, the approval or denial of medical 
 59.30  assistance funds to pay for out-of-state placements for 
 59.31  traumatic brain injury services and in-state traumatic brain 
 59.32  injury services provided by designated Medicare long-term care 
 59.33  hospitals; 
 59.34     (2) coordinating the traumatic brain injury home and 
 59.35  community-based waiver; 
 59.36     (3) approving traumatic brain injury waiver eligibility or 
 60.1   care plans or both; 
 60.2      (4) providing ongoing technical assistance and consultation 
 60.3   to county and facility case managers to facilitate care plan 
 60.4   development for appropriate, accessible, and cost-effective 
 60.5   medical assistance services; 
 60.6      (5) (4) providing technical assistance to promote statewide 
 60.7   development of appropriate, accessible, and cost-effective 
 60.8   medical assistance services and related policy; 
 60.9      (6) (5) providing training and outreach to facilitate 
 60.10  access to appropriate home and community-based services to 
 60.11  prevent institutionalization; 
 60.12     (7) (6) facilitating appropriate admissions, continued stay 
 60.13  review, discharges, and utilization review for neurobehavioral 
 60.14  hospitals and other specialized institutions; 
 60.15     (8) (7) providing technical assistance on the use of prior 
 60.16  authorization of home care services and coordination of these 
 60.17  services with other medical assistance services; 
 60.18     (9) (8) developing a system for identification of nursing 
 60.19  facility and hospital residents with traumatic brain injury to 
 60.20  assist in long-term planning for medical assistance services.  
 60.21  Factors will include, but are not limited to, number of 
 60.22  individuals served, length of stay, services received, and 
 60.23  barriers to community placement; and 
 60.24     (10) (9) providing information, referral, and case 
 60.25  consultation to access medical assistance services for 
 60.26  recipients without a county or facility case manager.  Direct 
 60.27  access to this assistance may be limited due to the structure of 
 60.28  the program. 
 60.29     Sec. 33.  Minnesota Statutes 2000, section 256B.095, is 
 60.30  amended to read: 
 60.31     256B.095 [THREE-YEAR QUALITY ASSURANCE PILOT PROJECT 
 60.32  ESTABLISHED.] 
 60.33     Effective July 1, 1998, an alternative quality assurance 
 60.34  licensing system pilot project for programs for persons with 
 60.35  developmental disabilities is established in Dodge, Fillmore, 
 60.36  Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, 
 61.1   Wabasha, and Winona counties for the purpose of improving the 
 61.2   quality of services provided to persons with developmental 
 61.3   disabilities.  A county, at its option, may choose to have all 
 61.4   programs for persons with developmental disabilities located 
 61.5   within the county licensed under chapter 245A using standards 
 61.6   determined under the alternative quality assurance licensing 
 61.7   system pilot project or may continue regulation of these 
 61.8   programs under the licensing system operated by the 
 61.9   commissioner.  The pilot project expires on June 30, 2001 2003. 
 61.10     Sec. 34.  Minnesota Statutes 2000, section 256B.0951, 
 61.11  subdivision 1, is amended to read: 
 61.12     Subdivision 1.  [MEMBERSHIP.] The region 10 quality 
 61.13  assurance commission is established.  The commission consists of 
 61.14  at least 14 but not more than 21 members as follows:  at least 
 61.15  three but not more than five members representing advocacy 
 61.16  organizations; at least three but not more than five members 
 61.17  representing consumers, families, and their legal 
 61.18  representatives; at least three but not more than five members 
 61.19  representing service providers; at least three but not more than 
 61.20  five members representing counties; and the commissioner of 
 61.21  human services or the commissioner's designee.  Initial 
 61.22  membership of the commission shall be recruited and approved by 
 61.23  the region 10 stakeholders group.  Prior to approving the 
 61.24  commission's membership, the stakeholders group shall provide to 
 61.25  the commissioner a list of the membership in the stakeholders 
 61.26  group, as of February 1, 1997, a brief summary of meetings held 
 61.27  by the group since July 1, 1996, and copies of any materials 
 61.28  prepared by the group for public distribution.  The first 
 61.29  commission shall establish membership guidelines for the 
 61.30  transition and recruitment of membership for the commission's 
 61.31  ongoing existence.  Members of the commission who do not receive 
 61.32  a salary or wages from an employer for time spent on commission 
 61.33  duties may receive a per diem payment when performing commission 
 61.34  duties and functions.  All members may be reimbursed for 
 61.35  expenses related to commission activities.  Notwithstanding the 
 61.36  provisions of section 15.059, subdivision 5, the commission 
 62.1   expires on June 30, 2001 2003. 
 62.2      Sec. 35.  Minnesota Statutes 2000, section 256B.0951, 
 62.3   subdivision 3, is amended to read: 
 62.4      Subd. 3.  [COMMISSION DUTIES.] (a) By October 1, 1997, the 
 62.5   commission, in cooperation with the commissioners of human 
 62.6   services and health, shall do the following:  (1) approve an 
 62.7   alternative quality assurance licensing system based on the 
 62.8   evaluation of outcomes; (2) approve measurable outcomes in the 
 62.9   areas of health and safety, consumer evaluation, education and 
 62.10  training, providers, and systems that shall be evaluated during 
 62.11  the alternative licensing process; and (3) establish variable 
 62.12  licensure periods not to exceed three years based on outcomes 
 62.13  achieved.  For purposes of this subdivision, "outcome" means the 
 62.14  behavior, action, or status of a person that can be observed or 
 62.15  measured and can be reliably and validly determined; and (4) 
 62.16  explore applications of the project to other populations or 
 62.17  geographic areas and describe efforts, including barriers to 
 62.18  expansion, in a report to the commissioner of human services by 
 62.19  January 15, 2003. 
 62.20     (b) By January 15, 1998, the commission shall approve, in 
 62.21  cooperation with the commissioner of human services, a training 
 62.22  program for members of the quality assurance teams established 
 62.23  under section 256B.0952, subdivision 4. 
 62.24     (c) The commission and the commissioner shall establish an 
 62.25  ongoing review process for the alternative quality assurance 
 62.26  licensing system.  The review shall take into account the 
 62.27  comprehensive nature of the alternative system, which is 
 62.28  designed to evaluate the broad spectrum of licensed and 
 62.29  unlicensed entities that provide services to clients, as 
 62.30  compared to the current licensing system.  
 62.31     (d) The commission shall contract with an independent 
 62.32  entity to conduct a financial review of the alternative quality 
 62.33  assurance pilot project.  The review shall take into account the 
 62.34  comprehensive nature of the alternative system, which is 
 62.35  designed to evaluate the broad spectrum of licensed and 
 62.36  unlicensed entities that provide services to clients, as 
 63.1   compared to the current licensing system.  The review shall 
 63.2   include an evaluation of possible budgetary savings within the 
 63.3   department of human services as a result of implementation of 
 63.4   the alternative quality assurance pilot project.  If a federal 
 63.5   waiver is approved under subdivision 7, the financial review 
 63.6   shall also evaluate possible savings within the department of 
 63.7   health.  This review must be completed by December 15, 2000. 
 63.8      (e) The commission shall submit a report to the legislature 
 63.9   by January 15, 2001, on the results of the review process for 
 63.10  the alternative quality assurance pilot project, a summary of 
 63.11  the results of the independent financial review, and a 
 63.12  recommendation on whether the pilot project should be extended 
 63.13  beyond June 30, 2001.  Based upon these recommendations, the 
 63.14  project will be extended to June 30, 2003. 
 63.15     Sec. 36.  Minnesota Statutes 2000, section 256B.0951, 
 63.16  subdivision 4, is amended to read: 
 63.17     Subd. 4.  [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF 
 63.18  LICENSING STANDARDS.] The commission may recommend to the 
 63.19  commissioners of human services and health variances from the 
 63.20  standards governing licensure of programs for persons with 
 63.21  developmental disabilities in order to improve the quality of 
 63.22  services by implementing an alternative developmental 
 63.23  disabilities licensing system if the commission determines that 
 63.24  the alternative licensing system does not negatively affect the 
 63.25  health or safety of persons being served by the licensed program 
 63.26  nor compromise the qualifications of staff to provide services. 
 63.27     Sec. 37.  Minnesota Statutes 2000, section 256B.0951, 
 63.28  subdivision 5, is amended to read: 
 63.29     Subd. 5.  [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The 
 63.30  safety standards, rights, or procedural protections under 
 63.31  sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 
 63.32  3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2) 
 63.33  and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, 
 63.34  subdivisions 1b, clause (7), and 10; 626.556; 626.557, and 
 63.35  procedures for the monitoring of psychotropic medications shall 
 63.36  not be varied under the alternative licensing system pilot 
 64.1   project.  The commission may make recommendations to the 
 64.2   commissioners of human services and health or to the legislature 
 64.3   regarding alternatives to or modifications of the rules and 
 64.4   procedures referenced in this subdivision. 
 64.5      Sec. 38.  Minnesota Statutes 2000, section 256B.0951, 
 64.6   subdivision 6, is amended to read: 
 64.7      Subd. 6.  [PROGRESS REPORT.] The commission shall submit a 
 64.8   progress report to the legislature on pilot project development 
 64.9   by January 15, 1998.  The report shall include recommendations 
 64.10  on any legislative changes necessary to improve cooperation 
 64.11  between the commission and the commissioners of human services 
 64.12  and health. 
 64.13     Sec. 39.  Minnesota Statutes 2000, section 256B.0951, 
 64.14  subdivision 7, is amended to read: 
 64.15     Subd. 7.  [WAIVER OF RULES.] The commissioner of health may 
 64.16  exempt residents of intermediate care facilities for persons 
 64.17  with mental retardation (ICFs/MR) who participate in the 
 64.18  three-year quality assurance pilot project established in 
 64.19  section 256B.095 from the requirements of Minnesota Rules, 
 64.20  chapter 4665, upon approval by the federal government of a 
 64.21  waiver of federal certification requirements for ICFs/MR.  The 
 64.22  commissioners of health and human services shall apply for any 
 64.23  necessary waivers as soon as practicable and shall submit the 
 64.24  concept paper to the federal government by June 1, 1998. 
 64.25     Sec. 40.  Minnesota Statutes 2000, section 256B.0951, is 
 64.26  amended by adding a subdivision to read: 
 64.27     Subd. 8.  [FEDERAL WAIVER.] The commissioner of human 
 64.28  services shall seek federal authority to waive provisions of 
 64.29  intermediate care facilities for persons with mental retardation 
 64.30  (ICFs/MR) regulations to enable the demonstration and evaluation 
 64.31  of the alternative quality assurance system for ICFs/MR under 
 64.32  the project. 
 64.33     Sec. 41.  Minnesota Statutes 2000, section 256B.0952, 
 64.34  subdivision 1, is amended to read: 
 64.35     Subdivision 1.  [NOTIFICATION.] By January 15, 1998, each 
 64.36  affected county shall notify the commission and the 
 65.1   commissioners of human services and health as to whether it 
 65.2   chooses to implement on July 1, 1998, the alternative licensing 
 65.3   system for the pilot project.  A county that does not implement 
 65.4   the alternative licensing system on July 1, 1998, may give 
 65.5   notice to the commission and the commissioners by January 15, 
 65.6   1999, or January 15, 2000, that it will implement the 
 65.7   alternative licensing system on the following July 1.  Region 10 
 65.8   counties may give notice to the commission and commissioners of 
 65.9   human services and health by March 15 to join or terminate 
 65.10  participation in the quality assurance alternative licensing 
 65.11  system on July 1 of that year for each year of the project.  A 
 65.12  county that implements choosing to participate in the 
 65.13  alternative licensing system commits to participate until June 
 65.14  30, 2001 2003.  Counties that choose to participate in the 
 65.15  quality assurance alternative licensing system prior to March 
 65.16  15, 2001, will need to notify the commission and commissioners 
 65.17  of human services and health of continued participation.  
 65.18  Counties who continue to participate must commit to participate 
 65.19  until June 30, 2003.  
 65.20     Sec. 42.  Minnesota Statutes 2000, section 256B.0952, 
 65.21  subdivision 4, is amended to read: 
 65.22     Subd. 4.  [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 
 65.23  county or group of counties that chooses to participate in the 
 65.24  alternative licensing system shall designate a quality assurance 
 65.25  manager and shall establish quality assurance teams in 
 65.26  accordance with subdivision 5.  The manager shall recruit, 
 65.27  train, and assign duties to the quality assurance team members.  
 65.28  In assigning team members to conduct the quality assurance 
 65.29  process at a facility, program, or service, the manager shall 
 65.30  take into account the size of the service provider, the number 
 65.31  of services to be reviewed, the skills necessary for team 
 65.32  members to complete the process, and other relevant factors.  
 65.33  The manager shall ensure that no team member has a financial, 
 65.34  personal, or family relationship with the facility, program, or 
 65.35  service being reviewed or with any clients of the facility, 
 65.36  program, or service. 
 66.1      (b) Quality assurance teams shall report the findings of 
 66.2   their quality assurance reviews to the quality assurance manager.
 66.3   The quality assurance manager shall provide the report from the 
 66.4   quality assurance team to the county and, upon request, 
 66.5   commissioners of human services and health and a summary of the 
 66.6   report to the quality assurance review council.  
 66.7      Sec. 43.  Minnesota Statutes 2000, section 256B.0955, is 
 66.8   amended to read: 
 66.9      256B.0955 [DUTIES OF THE COMMISSIONER OF HUMAN SERVICES.] 
 66.10     (a) Effective July 1, 1998, the commissioner of human 
 66.11  services shall delegate authority to perform licensing functions 
 66.12  and activities, in accordance with section 245A.16, to counties 
 66.13  participating in the alternative licensing system.  The 
 66.14  commissioner shall not license or reimburse a facility, program, 
 66.15  or service for persons with developmental disabilities in a 
 66.16  county that participates in the alternative licensing system if 
 66.17  the commissioner has received from the appropriate county 
 66.18  notification that the facility, program, or service has been 
 66.19  reviewed by a quality assurance team and has failed to qualify 
 66.20  for licensure. 
 66.21     (b) The commissioner may conduct random licensing 
 66.22  inspections based on outcomes adopted under section 256B.0951 at 
 66.23  facilities, programs, and services governed by the alternative 
 66.24  licensing system.  The role of such random inspections shall be 
 66.25  to verify that the alternative licensing system protects the 
 66.26  safety and well-being of consumers and maintains the 
 66.27  availability of high-quality services for persons with 
 66.28  developmental disabilities.  
 66.29     (c) The commissioner shall provide technical assistance and 
 66.30  support or training to the alternative licensing system pilot 
 66.31  project. 
 66.32     Sec. 44.  Minnesota Statutes 2000, section 256B.49, is 
 66.33  amended by adding a subdivision to read: 
 66.34     Subd. 11.  [AUTHORITY.] (a) The commissioner is authorized 
 66.35  to apply for home and community-based service waivers, as 
 66.36  authorized under section 1915(c) of the Social Security Act to 
 67.1   serve persons under the age of 65 who are determined to require 
 67.2   the level of care provided in a nursing home and persons who 
 67.3   require the level of care provided in a hospital.  The 
 67.4   commissioner shall apply for the home and community-based 
 67.5   waivers in order to:  (i) promote the support of persons with 
 67.6   disabilities in the most integrated settings; (ii) expand the 
 67.7   availability of services for persons who are eligible for 
 67.8   medical assistance; (iii) promote cost-effective options to 
 67.9   institutional care; and (iv) obtain federal financial 
 67.10  participation.  
 67.11     (b) The provision of waivered services to medical 
 67.12  assistance recipients with disabilities shall comply with the 
 67.13  requirements outlined in the federally approved applications for 
 67.14  home and community-based services and subsequent amendments, 
 67.15  including provision of services according to a service plan 
 67.16  designed to meet the needs of the individual.  For purposes of 
 67.17  this section, the approved home and community-based application 
 67.18  is considered the necessary federal requirement. 
 67.19     (c) The commissioner shall provide interested persons 
 67.20  serving on agency advisory committees and task forces, and 
 67.21  others upon request, with notice of, and an opportunity to 
 67.22  comment on, any changes or amendments to the federally approved 
 67.23  applications for home and community-based waivers, prior to 
 67.24  their submission to the federal health care financing 
 67.25  administration. 
 67.26     Sec. 45.  Minnesota Statutes 2000, section 256B.49, is 
 67.27  amended by adding a subdivision to read: 
 67.28     Subd. 12.  [INFORMED CHOICE.] Persons who are determined 
 67.29  likely to require the level of care provided in a nursing 
 67.30  facility or hospital shall be informed of the home and 
 67.31  community-based support alternatives to the provision of 
 67.32  inpatient hospital services or nursing facility services.  Each 
 67.33  person must be given the choice of either institutional or home 
 67.34  and community-based services, using the provisions described in 
 67.35  section 256B.77, subdivision 2, paragraph (p). 
 67.36     Sec. 46.  Minnesota Statutes 2000, section 256B.49, is 
 68.1   amended by adding a subdivision to read: 
 68.2      Subd. 13.  [CASE MANAGEMENT.] (a) Each recipient of a home 
 68.3   and community-based waiver shall be provided case management 
 68.4   services by qualified vendors as described in the federally 
 68.5   approved waiver application.  The case management service 
 68.6   activities provided will include: 
 68.7      (1) developing the written individual plan of care; 
 68.8      (2) informing the recipient or the recipient's legal 
 68.9   guardian or conservator of service options; 
 68.10     (3) assisting the recipient in the identification of 
 68.11  potential service providers; 
 68.12     (4) assisting the recipient to access services; 
 68.13     (5) coordinating, evaluating, and monitoring of the 
 68.14  services identified in the plan of care; and 
 68.15     (6) completing the annual reviews of the plan of care. 
 68.16     (b) The case manager may delegate certain aspects of the 
 68.17  case management service activities to another individual 
 68.18  provided there is oversight by the case manager.  The case 
 68.19  manager may not delegate those aspects which require 
 68.20  professional judgment including assessments, reassessments, and 
 68.21  care plan development. 
 68.22     Sec. 47.  Minnesota Statutes 2000, section 256B.49, is 
 68.23  amended by adding a subdivision to read: 
 68.24     Subd. 14.  [ASSESSMENT AND REASSESSMENT.] (a) Assessments 
 68.25  of each recipient's strengths, informal support systems, and 
 68.26  need for services shall occur as indicated in the federally 
 68.27  approved waiver plan.  Reassessment of each recipient's 
 68.28  strengths, support systems, and need for services shall be 
 68.29  conducted at least every 12 months and at other times when there 
 68.30  has been a significant change in the recipient's functioning. 
 68.31     (b) Persons with mental retardation or a related condition 
 68.32  who apply for services under the nursing facility level waiver 
 68.33  programs shall be screened for the appropriate level of care 
 68.34  according to section 256B.092. 
 68.35     (c) Recipients who are found eligible for home and 
 68.36  community-based services under this section before their 65th 
 69.1   birthday may remain eligible for these services after their 65th 
 69.2   birthday if they continue to meet all other eligibility factors. 
 69.3      Sec. 48.  Minnesota Statutes 2000, section 256B.49, is 
 69.4   amended by adding a subdivision to read: 
 69.5      Subd. 15.  [INDIVIDUALIZED PLAN OF CARE.] Each recipient of 
 69.6   home and community-based waivered services shall have a written 
 69.7   plan of care which: 
 69.8      (1) reasonably ensures the health and safety of the 
 69.9   recipient; 
 69.10     (2) promotes independence; 
 69.11     (3) allows for services to be provided in the most 
 69.12  integrated settings; and 
 69.13     (4) provides for an informed choice, as defined in section 
 69.14  256B.77, subdivision 2, paragraph (p), of service and support 
 69.15  providers. 
 69.16     Sec. 49.  Minnesota Statutes 2000, section 256B.49, is 
 69.17  amended by adding a subdivision to read: 
 69.18     Subd. 16.  [SERVICES AND SUPPORTS.] Services and supports 
 69.19  included in the home and community-based waivers for persons 
 69.20  with disabilities shall meet the requirements set out in United 
 69.21  States Code, title 42, section 1396n.  The services and 
 69.22  supports, which are offered as alternatives to institutional 
 69.23  care, shall promote consumer choice, community inclusion, 
 69.24  self-sufficiency, and self-determination.  Beginning January 1, 
 69.25  2003, the commissioner shall simplify and improve access to home 
 69.26  and community-based waivered services, to the extent possible, 
 69.27  through the establishment of a common service menu that is 
 69.28  available to eligible recipients regardless of age, disability 
 69.29  type, or waiver program.  Consumer directed community support 
 69.30  services shall be offered as an option to all persons eligible 
 69.31  for services under section 256B.49, subdivision 11, by January 
 69.32  1, 2002.  Services and supports shall be arranged and provided 
 69.33  consistent with individualized written plans of care for 
 69.34  eligible waiver recipients. 
 69.35     Sec. 50.  Minnesota Statutes 2000, section 256B.49, is 
 69.36  amended by adding a subdivision to read: 
 70.1      Subd. 17.  [COST OF SERVICES AND SUPPORTS.] (a) The 
 70.2   commissioner shall ensure that the average per capita 
 70.3   expenditures estimated in any fiscal year for home and 
 70.4   community-based waiver recipients does not exceed the average 
 70.5   per capita expenditures that would have been made to provide 
 70.6   institutional services for recipients in the absence of the 
 70.7   waiver. 
 70.8      (b) The commissioner shall implement on January 1, 2002, 
 70.9   one or more aggregate, need-based methods for allocating to 
 70.10  local agencies the home and community-based waivered service 
 70.11  resources available to support recipients with disabilities in 
 70.12  need of the level of care provided in a nursing facility or a 
 70.13  hospital.  The commissioner shall allocate resources to single 
 70.14  counties and county partnerships in a manner that reflects 
 70.15  consideration of:  (i) an incentive-based payment process for 
 70.16  achieving outcomes; (ii) a state-level risk pool; (iii) the need 
 70.17  for retention of management responsibility at the state agency 
 70.18  level; and (iv) a phase-in strategy as appropriate. 
 70.19     (c) Until the allocation methods described in paragraph (b) 
 70.20  are implemented, the annual allowable reimbursement level of 
 70.21  home and community-based waiver services shall be the greater of:
 70.22     (1) The statewide average payment amount which the 
 70.23  recipient is assigned under the waiver reimbursement system in 
 70.24  place on June 30, 2001, modified by the percentage of any 
 70.25  provider rate increase appropriated for home and community-based 
 70.26  services. 
 70.27     (2) An amount approved by the commissioner based on the 
 70.28  recipient's extraordinary needs that cannot be met within the 
 70.29  current allowable reimbursement level.  The increased 
 70.30  reimbursement level must be necessary to allow the recipient to 
 70.31  be discharged from an institution or to prevent imminent 
 70.32  placement in an institution.  The additional reimbursement may 
 70.33  be used to secure environmental modifications; assistive 
 70.34  technology and equipment; and increased costs for supervision, 
 70.35  training, and support services necessary to address the 
 70.36  recipient's extraordinary needs.  The commissioner may approve 
 71.1   an increased reimbursement level for up to one year of the 
 71.2   recipient's relocation from an institution or up to six months 
 71.3   of a determination that a current waiver recipient is at 
 71.4   imminent risk of being placed in an institution. 
 71.5      (d) Beginning July 1, 2001, medically necessary private 
 71.6   duty nursing services will be authorized under this section as 
 71.7   complex and regular care according to section 256B.0627.  The 
 71.8   rate established by the commissioner for registered nurse or 
 71.9   licensed practical nurse services under any home and 
 71.10  community-based waiver as of January 1, 2001, shall not be 
 71.11  reduced. 
 71.12     Sec. 51.  Minnesota Statutes 2000, section 256B.49, is 
 71.13  amended by adding a subdivision to read: 
 71.14     Subd. 18.  [PAYMENTS.] The commissioner shall reimburse 
 71.15  approved vendors from the medical assistance account for the 
 71.16  costs of providing home and community-based services to eligible 
 71.17  recipients using the invoice processing procedures of the 
 71.18  Medicaid management information system (MMIS).  Recipients will 
 71.19  be screened and authorized for services according to the 
 71.20  federally approved waiver application and its subsequent 
 71.21  amendments. 
 71.22     Sec. 52.  Minnesota Statutes 2000, section 256B.49, is 
 71.23  amended by adding a subdivision to read: 
 71.24     Subd. 19.  [HEALTH AND WELFARE.] The commissioner of human 
 71.25  services shall take the necessary safeguards to protect the 
 71.26  health and welfare of individuals provided services under the 
 71.27  waiver. 
 71.28     Sec. 53.  Minnesota Statutes 2000, section 256B.49, is 
 71.29  amended by adding a subdivision to read: 
 71.30     Subd. 20.  [TRAUMATIC BRAIN INJURY AND RELATED CONDITIONS.] 
 71.31  The commissioner shall seek to amend the traumatic brain injury 
 71.32  waiver to include, as eligible persons, individuals with an 
 71.33  acquired or degenerative disease diagnosis where cognitive 
 71.34  impairment is present, such as multiple sclerosis. 
 71.35     Sec. 54.  Minnesota Statutes 2000, section 256B.5012, is 
 71.36  amended by adding a subdivision to read: 
 72.1      Subd. 4.  [FACILITY RATE INCREASES EFFECTIVE JANUARY 1, 
 72.2   2003.] For the rate year beginning January 1, 2003, for 
 72.3   intermediate care facilities reimbursed under this section, the 
 72.4   commissioner shall increase the total payment rate in effect for 
 72.5   each facility on December 31, 2002, by 2.0 percent.  This 
 72.6   increase shall be incorporated into ongoing facility per diems 
 72.7   as part of the permanent total payment rate. 
 72.8      Sec. 55.  Minnesota Statutes 2000, section 256D.35, is 
 72.9   amended by adding a subdivision to read: 
 72.10     Subd. 11a.  [INSTITUTION.] "Institution" means:  a 
 72.11  hospital, consistent with Code of Federal Regulations, title 42, 
 72.12  section 440.10; regional treatment center inpatient services; a 
 72.13  nursing facility; and an intermediate care facility for persons 
 72.14  with mental retardation. 
 72.15     Sec. 56.  Minnesota Statutes 2000, section 256D.35, is 
 72.16  amended by adding a subdivision to read: 
 72.17     Subd. 18a.  [SHELTER COSTS.] "Shelter costs" means:  rent, 
 72.18  manufactured home lot rentals; monthly principal, interest, 
 72.19  insurance premiums, and property taxes due for mortgages or 
 72.20  contract for deed costs; costs for utilities, including heating, 
 72.21  cooling, electricity, water, and sewerage; garbage collection 
 72.22  fees; and the basic service fee for one telephone. 
 72.23     Sec. 57.  Minnesota Statutes 2000, section 256D.44, 
 72.24  subdivision 5, is amended to read: 
 72.25     Subd. 5.  [SPECIAL NEEDS.] In addition to the state 
 72.26  standards of assistance established in subdivisions 1 to 4, 
 72.27  payments are allowed for the following special needs of 
 72.28  recipients of Minnesota supplemental aid who are not residents 
 72.29  of a nursing home, a regional treatment center, or a group 
 72.30  residential housing facility. 
 72.31     (a) The county agency shall pay a monthly allowance for 
 72.32  medically prescribed diets payable under the Minnesota family 
 72.33  investment program if the cost of those additional dietary needs 
 72.34  cannot be met through some other maintenance benefit.  
 72.35     (b) Payment for nonrecurring special needs must be allowed 
 72.36  for necessary home repairs or necessary repairs or replacement 
 73.1   of household furniture and appliances using the payment standard 
 73.2   of the AFDC program in effect on July 16, 1996, for these 
 73.3   expenses, as long as other funding sources are not available.  
 73.4      (c) A fee for guardian or conservator service is allowed at 
 73.5   a reasonable rate negotiated by the county or approved by the 
 73.6   court.  This rate shall not exceed five percent of the 
 73.7   assistance unit's gross monthly income up to a maximum of $100 
 73.8   per month.  If the guardian or conservator is a member of the 
 73.9   county agency staff, no fee is allowed. 
 73.10     (d) The county agency shall continue to pay a monthly 
 73.11  allowance of $68 for restaurant meals for a person who was 
 73.12  receiving a restaurant meal allowance on June 1, 1990, and who 
 73.13  eats two or more meals in a restaurant daily.  The allowance 
 73.14  must continue until the person has not received Minnesota 
 73.15  supplemental aid for one full calendar month or until the 
 73.16  person's living arrangement changes and the person no longer 
 73.17  meets the criteria for the restaurant meal allowance, whichever 
 73.18  occurs first. 
 73.19     (e) A fee of ten percent of the recipient's gross income or 
 73.20  $25, whichever is less, is allowed for representative payee 
 73.21  services provided by an agency that meets the requirements under 
 73.22  SSI regulations to charge a fee for representative payee 
 73.23  services.  This special need is available to all recipients of 
 73.24  Minnesota supplemental aid regardless of their living 
 73.25  arrangement.  
 73.26     (f) Notwithstanding the language in this subdivision, an 
 73.27  amount equal to the maximum allotment authorized by the federal 
 73.28  Food Stamp Program for a single individual which is in effect on 
 73.29  the first day of January of the previous year will be added to 
 73.30  the standards of assistance established in subdivisions 1 to 4 
 73.31  for individuals under the age of 65 who are relocating from an 
 73.32  institution and who are shelter needy.  An eligible individual 
 73.33  who receives this benefit prior to age 65 may continue to 
 73.34  receive the benefit after the age of 65. 
 73.35     "Shelter needy" means that the assistance unit incurs 
 73.36  monthly shelter costs that exceed 40 percent of the assistance 
 74.1   unit's gross income before the application of this special needs 
 74.2   standard.  "Gross income" for the purposes of this section is 
 74.3   the applicant's or recipient's income as defined in section 
 74.4   256D.35, subdivision 10, or the standard specified in 
 74.5   subdivision 3, whichever is greater.  A recipient of a federal 
 74.6   or state housing subsidy, that limits shelter costs to a 
 74.7   percentage of gross income, shall not be considered shelter 
 74.8   needy for purposes of this paragraph.