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; authorizing 
  1.6             medical assistance targeted case management for 
  1.7             certain persons; creating a consumer-directed home 
  1.8             care demonstration project; requiring the commissioner 
  1.9             of human services to seek certain federal waivers; 
  1.10            requiring a study of semi-independent living services; 
  1.11            authorizing traumatic brain injury pilot project 
  1.12            grants; appropriating money; amending Minnesota 
  1.13            Statutes 2000, sections 245A.13, subdivisions 7, 8; 
  1.14            252.275, subdivision 4b; 254B.03, subdivision 1; 
  1.15            254B.09, by adding a subdivision; 256.01, by adding a 
  1.16            subdivision; 256.476, subdivisions 1, 2, 3, 4, 5, 8; 
  1.17            256B.0625, subdivisions 7, 19a, 19c, 20, by adding 
  1.18            subdivisions; 256B.0627, subdivisions 1, 2, 4, 5, 7, 
  1.19            8, 10, 11, by adding subdivisions; 256B.0911, by 
  1.20            adding a subdivision; 256B.093, subdivision 3; 
  1.21            256B.095; 256B.0951, subdivisions 1, 3, 4, 5, 6, 7, by 
  1.22            adding a subdivision; 256B.0952, subdivisions 1, 4; 
  1.23            256B.0955; 256B.49, by adding subdivisions; 256B.5012, 
  1.24            by adding a subdivision; 256D.35, by adding 
  1.25            subdivisions; 256D.44, subdivision 5; repealing 
  1.26            Minnesota Statutes 2000, sections 145.9245; 256.476, 
  1.27            subdivision 7; 256B.0912; 256B.0915, subdivisions 3a, 
  1.28            3b, 3c; 256B.49, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 
  1.29            9, 10; Minnesota Rules, parts 9505.2455; 9505.2458; 
  1.30            9505.2460; 9505.2465; 9505.2470; 9505.2473; 9505.2475; 
  1.31            9505.2480; 9505.2485; 9505.2486; 9505.2490; 9505.2495; 
  1.32            9505.2496; 9505.2500; 9505.3010; 9505.3015; 9505.3020; 
  1.33            9505.3025; 9505.3030; 9505.3035; 9505.3040; 9505.3065; 
  1.34            9505.3085; 9505.3135; 9505.3500; 9505.3510; 9505.3520; 
  1.35            9505.3530; 9505.3535; 9505.3540; 9505.3545; 9505.3550; 
  1.36            9505.3560; 9505.3570; 9505.3575; 9505.3580; 9505.3585; 
  1.37            9505.3600; 9505.3610; 9505.3620; 9505.3622; 9505.3624; 
  1.38            9505.3626; 9505.3630; 9505.3635; 9505.3640; 9505.3645; 
  1.39            9505.3650; 9505.3660; 9505.3670. 
  1.40  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.41     Section 1.  Minnesota Statutes 2000, section 245A.13, 
  1.42  subdivision 7, is amended to read: 
  2.1      Subd. 7.  [RATE RECOMMENDATION.] The commissioner of human 
  2.2   services may review rates of a residential program participating 
  2.3   in the medical assistance program which is in receivership and 
  2.4   that has needs or deficiencies documented by the department of 
  2.5   health or the department of human services.  If the commissioner 
  2.6   of human services determines that a review of the rate 
  2.7   established under section 256B.501 sections 256B.5012 and 
  2.8   256B.5013 is needed, the commissioner shall: 
  2.9      (1) review the order or determination that cites the 
  2.10  deficiencies or needs; and 
  2.11     (2) determine the need for additional staff, additional 
  2.12  annual hours by type of employee, and additional consultants, 
  2.13  services, supplies, equipment, repairs, or capital assets 
  2.14  necessary to satisfy the needs or deficiencies. 
  2.15     Sec. 2.  Minnesota Statutes 2000, section 245A.13, 
  2.16  subdivision 8, is amended to read: 
  2.17     Subd. 8.  [ADJUSTMENT TO THE RATE.] Upon review of rates 
  2.18  under subdivision 7, the commissioner may adjust the residential 
  2.19  program's payment rate.  The commissioner shall review the 
  2.20  circumstances, together with the residential program cost report 
  2.21  program's most recent income and expense report, to determine 
  2.22  whether or not the deficiencies or needs can be corrected or met 
  2.23  by reallocating residential program staff, costs, revenues, 
  2.24  or any other resources including any investments, efficiency 
  2.25  incentives, or allowances.  If the commissioner determines that 
  2.26  any deficiency cannot be corrected or the need cannot be met 
  2.27  with the payment rate currently being paid, the commissioner 
  2.28  shall determine the payment rate adjustment by dividing the 
  2.29  additional annual costs established during the commissioner's 
  2.30  review by the residential program's actual resident days from 
  2.31  the most recent desk-audited cost income and expense report or 
  2.32  the estimated resident days in the projected receivership 
  2.33  period.  The payment rate adjustment must meet the conditions in 
  2.34  Minnesota Rules, parts 9553.0010 to 9553.0080, and remains in 
  2.35  effect during the period of the receivership or until another 
  2.36  date set by the commissioner.  Upon the subsequent sale, 
  3.1   closure, or transfer of the residential program, the 
  3.2   commissioner may recover amounts that were paid as payment rate 
  3.3   adjustments under this subdivision.  This recovery shall be 
  3.4   determined through a review of actual costs and resident days in 
  3.5   the receivership period.  The costs the commissioner finds to be 
  3.6   allowable shall be divided by the actual resident days for the 
  3.7   receivership period.  This rate shall be compared to the rate 
  3.8   paid throughout the receivership period, with the difference 
  3.9   multiplied by resident days, being the amount to be repaid to 
  3.10  the commissioner.  Allowable costs shall be determined by the 
  3.11  commissioner as those ordinary, necessary, and related to 
  3.12  resident care by prudent and cost-conscious management.  The 
  3.13  buyer or transferee shall repay this amount to the commissioner 
  3.14  within 60 days after the commissioner notifies the buyer or 
  3.15  transferee of the obligation to repay.  This provision does not 
  3.16  limit the liability of the seller to the commissioner pursuant 
  3.17  to section 256B.0641. 
  3.18     Sec. 3.  Minnesota Statutes 2000, section 252.275, 
  3.19  subdivision 4b, is amended to read: 
  3.20     Subd. 4b.  [GUARANTEED FLOOR.] Each county with an original 
  3.21  allocation for the preceding year that is equal to or less than 
  3.22  the guaranteed floor minimum index shall have a guaranteed floor 
  3.23  equal to its original allocation for the preceding year.  Each 
  3.24  county with an original allocation for the preceding year that 
  3.25  is greater than the guaranteed floor minimum index shall have a 
  3.26  guaranteed floor equal to the lesser of clause (1) or (2): 
  3.27     (1) the county's original allocation for the preceding 
  3.28  year; or 
  3.29     (2) 70 percent of the county's reported expenditures 
  3.30  eligible for reimbursement during the 12 months ending on June 
  3.31  30 of the preceding calendar year. 
  3.32     For calendar year 1993, the guaranteed floor minimum index 
  3.33  shall be $20,000.  For each subsequent year, the index shall be 
  3.34  adjusted by the projected change in the average value in the 
  3.35  United States Department of Labor Bureau of Labor Statistics 
  3.36  consumer price index (all urban) for that year. 
  4.1      Notwithstanding this subdivision, no county shall be 
  4.2   allocated a guaranteed floor of less than $1,000. 
  4.3      When the amount of funds available for allocation is less 
  4.4   than the amount available in the previous year, each county's 
  4.5   previous year allocation shall be reduced in proportion to the 
  4.6   reduction in the statewide funding, to establish each county's 
  4.7   guaranteed floor. 
  4.8      Sec. 4.  Minnesota Statutes 2000, section 254B.03, 
  4.9   subdivision 1, is amended to read: 
  4.10     Subdivision 1.  [LOCAL AGENCY DUTIES.] (a) Every local 
  4.11  agency shall provide chemical dependency services to persons 
  4.12  residing within its jurisdiction who meet criteria established 
  4.13  by the commissioner for placement in a chemical dependency 
  4.14  residential or nonresidential treatment service.  Chemical 
  4.15  dependency money must be administered by the local agencies 
  4.16  according to law and rules adopted by the commissioner under 
  4.17  sections 14.001 to 14.69. 
  4.18     (b) In order to contain costs, the county board shall, with 
  4.19  the approval of the commissioner of human services, select 
  4.20  eligible vendors of chemical dependency services who can provide 
  4.21  economical and appropriate treatment.  Unless the local agency 
  4.22  is a social services department directly administered by a 
  4.23  county or human services board, the local agency shall not be an 
  4.24  eligible vendor under section 254B.05.  The commissioner may 
  4.25  approve proposals from county boards to provide services in an 
  4.26  economical manner or to control utilization, with safeguards to 
  4.27  ensure that necessary services are provided.  If a county 
  4.28  implements a demonstration or experimental medical services 
  4.29  funding plan, the commissioner shall transfer the money as 
  4.30  appropriate.  If a county selects a vendor located in another 
  4.31  state, the county shall ensure that the vendor is in compliance 
  4.32  with the rules governing licensure of programs located in the 
  4.33  state. 
  4.34     (c) The calendar year 1998 2002 rate for vendors may not 
  4.35  increase more than three two percent above the rate approved in 
  4.36  effect on January 1, 1997 2001.  The calendar year 1999 2003 
  5.1   rate for vendors may not increase more than three two percent 
  5.2   above the rate in effect on January 1, 1998 2002. 
  5.3      (d) A culturally specific vendor that provides assessments 
  5.4   under a variance under Minnesota Rules, part 9530.6610, shall be 
  5.5   allowed to provide assessment services to persons not covered by 
  5.6   the variance. 
  5.7      Sec. 5.  Minnesota Statutes 2000, section 254B.09, is 
  5.8   amended by adding a subdivision to read: 
  5.9      Subd. 8.  [PAYMENTS TO IMPROVE SERVICES TO AMERICAN 
  5.10  INDIANS.] The commissioner may set rates for chemical dependency 
  5.11  services according to the American Indian Health Improvement 
  5.12  Act, Public Law Number 94-437, for eligible vendors.  These 
  5.13  rates shall supersede rates set in county purchase of service 
  5.14  agreements when payments are made on behalf of clients eligible 
  5.15  according to Public Law Number 94-437. 
  5.16     Sec. 6.  Minnesota Statutes 2000, section 256.01, is 
  5.17  amended by adding a subdivision to read: 
  5.18     Subd. 19.  [GRANTS FOR CASE MANAGEMENT SERVICES TO PERSONS 
  5.19  WITH HIV OR AIDS.] The commissioner may award grants to eligible 
  5.20  vendors for the development, implementation, and evaluation of 
  5.21  case management services for individuals infected with the human 
  5.22  immunodeficiency virus.  HIV/AIDs case management services will 
  5.23  be provided to increase access to cost effective health care 
  5.24  services, to reduce the risk of HIV transmission, to ensure that 
  5.25  basic client needs are met, and to increase client access to 
  5.26  needed community supports or services. 
  5.27     Sec. 7.  Minnesota Statutes 2000, section 256.476, 
  5.28  subdivision 1, is amended to read: 
  5.29     Subdivision 1.  [PURPOSE AND GOALS.] The commissioner of 
  5.30  human services shall establish a consumer support grant 
  5.31  program to assist for individuals with functional limitations 
  5.32  and their families in purchasing and securing supports which the 
  5.33  individuals need to live as independently and productively in 
  5.34  the community as possible who wish to purchase and secure their 
  5.35  own supports.  The commissioner and local agencies shall jointly 
  5.36  develop an implementation plan which must include a way to 
  6.1   resolve the issues related to county liability.  The program 
  6.2   shall: 
  6.3      (1) make support grants available to individuals or 
  6.4   families as an effective alternative to existing programs and 
  6.5   services, such as the developmental disability family support 
  6.6   program, the alternative care program, personal care attendant 
  6.7   services, home health aide services, and private duty nursing 
  6.8   facility services; 
  6.9      (2) provide consumers more control, flexibility, and 
  6.10  responsibility over the needed supports their services and 
  6.11  supports; 
  6.12     (3) promote local program management and decision making; 
  6.13  and 
  6.14     (4) encourage the use of informal and typical community 
  6.15  supports. 
  6.16     Sec. 8.  Minnesota Statutes 2000, section 256.476, 
  6.17  subdivision 2, is amended to read: 
  6.18     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  6.19  following terms have the meanings given them: 
  6.20     (a) "County board" means the county board of commissioners 
  6.21  for the county of financial responsibility as defined in section 
  6.22  256G.02, subdivision 4, or its designated representative.  When 
  6.23  a human services board has been established under sections 
  6.24  402.01 to 402.10, it shall be considered the county board for 
  6.25  the purposes of this section. 
  6.26     (b) "Family" means the person's birth parents, adoptive 
  6.27  parents or stepparents, siblings or stepsiblings, children or 
  6.28  stepchildren, grandparents, grandchildren, niece, nephew, aunt, 
  6.29  uncle, or spouse.  For the purposes of this section, a family 
  6.30  member is at least 18 years of age. 
  6.31     (c) "Functional limitations" means the long-term inability 
  6.32  to perform an activity or task in one or more areas of major 
  6.33  life activity, including self-care, understanding and use of 
  6.34  language, learning, mobility, self-direction, and capacity for 
  6.35  independent living.  For the purpose of this section, the 
  6.36  inability to perform an activity or task results from a mental, 
  7.1   emotional, psychological, sensory, or physical disability, 
  7.2   condition, or illness. 
  7.3      (d) "Informed choice" means a voluntary decision made by 
  7.4   the person or the person's legal representative, after becoming 
  7.5   familiarized with the alternatives to: 
  7.6      (1) select a preferred alternative from a number of 
  7.7   feasible alternatives; 
  7.8      (2) select an alternative which may be developed in the 
  7.9   future; and 
  7.10     (3) refuse any or all alternatives. 
  7.11     (e) "Local agency" means the local agency authorized by the 
  7.12  county board to carry out the provisions of this section. 
  7.13     (f) "Person" or "persons" means a person or persons meeting 
  7.14  the eligibility criteria in subdivision 3. 
  7.15     (g) "Authorized representative" means an individual 
  7.16  designated by the person or their legal representative to act on 
  7.17  their behalf.  This individual may be a family member, guardian, 
  7.18  representative payee, or other individual designated by the 
  7.19  person or their legal representative, if any, to assist in 
  7.20  purchasing and arranging for supports.  For the purposes of this 
  7.21  section, an authorized representative is at least 18 years of 
  7.22  age. 
  7.23     (h) "Screening" means the screening of a person's service 
  7.24  needs under sections 256B.0911 and 256B.092. 
  7.25     (i) "Supports" means services, care, aids, home 
  7.26  environmental modifications, or assistance purchased by the 
  7.27  person or the person's family.  Examples of supports include 
  7.28  respite care, assistance with daily living, and adaptive aids 
  7.29  assistive technology.  For the purpose of this section, 
  7.30  notwithstanding the provisions of section 144A.43, supports 
  7.31  purchased under the consumer support program are not considered 
  7.32  home care services. 
  7.33     (j) "Program of origination" means the program the 
  7.34  individual transferred from when approved for the consumer 
  7.35  support grant program. 
  7.36     Sec. 9.  Minnesota Statutes 2000, section 256.476, 
  8.1   subdivision 3, is amended to read: 
  8.2      Subd. 3.  [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person 
  8.3   is eligible to apply for a consumer support grant if the person 
  8.4   meets all of the following criteria: 
  8.5      (1) the person is eligible for and has been approved to 
  8.6   receive services under medical assistance as determined under 
  8.7   sections 256B.055 and 256B.056 or the person is eligible for and 
  8.8   has been approved to receive services under alternative care 
  8.9   services as determined under section 256B.0913 or the person has 
  8.10  been approved to receive a grant under the developmental 
  8.11  disability family support program under section 252.32; 
  8.12     (2) the person is able to direct and purchase the person's 
  8.13  own care and supports, or the person has a family member, legal 
  8.14  representative, or other authorized representative who can 
  8.15  purchase and arrange supports on the person's behalf; 
  8.16     (3) the person has functional limitations, requires ongoing 
  8.17  supports to live in the community, and is at risk of or would 
  8.18  continue institutionalization without such supports; and 
  8.19     (4) the person will live in a home.  For the purpose of 
  8.20  this section, "home" means the person's own home or home of a 
  8.21  person's family member.  These homes are natural home settings 
  8.22  and are not licensed by the department of health or human 
  8.23  services. 
  8.24     (b) Persons may not concurrently receive a consumer support 
  8.25  grant if they are: 
  8.26     (1) receiving home and community-based services under 
  8.27  United States Code, title 42, section 1396h(c); personal care 
  8.28  attendant and home health aide services under section 256B.0625; 
  8.29  a developmental disability family support grant; or alternative 
  8.30  care services under section 256B.0913; or 
  8.31     (2) residing in an institutional or congregate care setting.
  8.32     (c) A person or person's family receiving a consumer 
  8.33  support grant shall not be charged a fee or premium by a local 
  8.34  agency for participating in the program.  
  8.35     (d) The commissioner may limit the participation of nursing 
  8.36  facility residents, residents of intermediate care facilities 
  9.1   for persons with mental retardation, and the recipients of 
  9.2   services from federal waiver programs in the consumer support 
  9.3   grant program if the participation of these individuals will 
  9.4   result in an increase in the cost to the state. 
  9.5      (e) The commissioner shall establish a budgeted 
  9.6   appropriation each fiscal year for the consumer support grant 
  9.7   program.  The number of individuals participating in the program 
  9.8   will be adjusted so the total amount allocated to counties does 
  9.9   not exceed the amount of the budgeted appropriation.  The 
  9.10  budgeted appropriation will be adjusted annually to accommodate 
  9.11  changes in demand for the consumer support grants. 
  9.12     Sec. 10.  Minnesota Statutes 2000, section 256.476, 
  9.13  subdivision 4, is amended to read: 
  9.14     Subd. 4.  [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 
  9.15  county board may choose to participate in the consumer support 
  9.16  grant program.  If a county board chooses to participate in the 
  9.17  program, the local agency shall establish written procedures and 
  9.18  criteria to determine the amount and use of support grants.  
  9.19  These procedures must include, at least, the availability of 
  9.20  respite care, assistance with daily living, and adaptive aids.  
  9.21  The local agency may establish monthly or annual maximum amounts 
  9.22  for grants and procedures where exceptional resources may be 
  9.23  required to meet the health and safety needs of the person on a 
  9.24  time-limited basis, however, the total amount awarded to each 
  9.25  individual may not exceed the limits established in subdivision 
  9.26  5, paragraph (f). 
  9.27     (b) Support grants to a person or a person's family will be 
  9.28  provided through a monthly subsidy payment and be in the form of 
  9.29  cash, voucher, or direct county payment to vendor.  Support 
  9.30  grant amounts must be determined by the local agency.  Each 
  9.31  service and item purchased with a support grant must meet all of 
  9.32  the following criteria:  
  9.33     (1) it must be over and above the normal cost of caring for 
  9.34  the person if the person did not have functional limitations; 
  9.35     (2) it must be directly attributable to the person's 
  9.36  functional limitations; 
 10.1      (3) it must enable the person or the person's family to 
 10.2   delay or prevent out-of-home placement of the person; and 
 10.3      (4) it must be consistent with the needs identified in the 
 10.4   service plan, when applicable. 
 10.5      (c) Items and services purchased with support grants must 
 10.6   be those for which there are no other public or private funds 
 10.7   available to the person or the person's family.  Fees assessed 
 10.8   to the person or the person's family for health and human 
 10.9   services are not reimbursable through the grant. 
 10.10     (d) In approving or denying applications, the local agency 
 10.11  shall consider the following factors:  
 10.12     (1) the extent and areas of the person's functional 
 10.13  limitations; 
 10.14     (2) the degree of need in the home environment for 
 10.15  additional support; and 
 10.16     (3) the potential effectiveness of the grant to maintain 
 10.17  and support the person in the family environment or the person's 
 10.18  own home. 
 10.19     (e) At the time of application to the program or screening 
 10.20  for other services, the person or the person's family shall be 
 10.21  provided sufficient information to ensure an informed choice of 
 10.22  alternatives by the person, the person's legal representative, 
 10.23  if any, or the person's family.  The application shall be made 
 10.24  to the local agency and shall specify the needs of the person 
 10.25  and family, the form and amount of grant requested, the items 
 10.26  and services to be reimbursed, and evidence of eligibility for 
 10.27  medical assistance or alternative care program. 
 10.28     (f) Upon approval of an application by the local agency and 
 10.29  agreement on a support plan for the person or person's family, 
 10.30  the local agency shall make grants to the person or the person's 
 10.31  family.  The grant shall be in an amount for the direct costs of 
 10.32  the services or supports outlined in the service agreement.  
 10.33     (g) Reimbursable costs shall not include costs for 
 10.34  resources already available, such as special education classes, 
 10.35  day training and habilitation, case management, other services 
 10.36  to which the person is entitled, medical costs covered by 
 11.1   insurance or other health programs, or other resources usually 
 11.2   available at no cost to the person or the person's family. 
 11.3      (h) The state of Minnesota, the county boards participating 
 11.4   in the consumer support grant program, or the agencies acting on 
 11.5   behalf of the county boards in the implementation and 
 11.6   administration of the consumer support grant program shall not 
 11.7   be liable for damages, injuries, or liabilities sustained 
 11.8   through the purchase of support by the individual, the 
 11.9   individual's family, or the authorized representative under this 
 11.10  section with funds received through the consumer support grant 
 11.11  program.  Liabilities include but are not limited to:  workers' 
 11.12  compensation liability, the Federal Insurance Contributions Act 
 11.13  (FICA), or the Federal Unemployment Tax Act (FUTA).  For 
 11.14  purposes of this section, participating county boards and 
 11.15  agencies acting on behalf of county boards are exempt from the 
 11.16  provisions of section 268.04. 
 11.17     Sec. 11.  Minnesota Statutes 2000, section 256.476, 
 11.18  subdivision 5, is amended to read: 
 11.19     Subd. 5.  [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 
 11.20  For the purpose of transferring persons to the consumer support 
 11.21  grant program from specific programs or services, such as the 
 11.22  developmental disability family support program and alternative 
 11.23  care program, personal care attendant assistant services, home 
 11.24  health aide services, or nursing facility private duty nursing 
 11.25  services, the amount of funds transferred by the commissioner 
 11.26  between the developmental disability family support program 
 11.27  account, the alternative care account, the medical assistance 
 11.28  account, or the consumer support grant account shall be based on 
 11.29  each county's participation in transferring persons to the 
 11.30  consumer support grant program from those programs and services. 
 11.31     (b) At the beginning of each fiscal year, county 
 11.32  allocations for consumer support grants shall be based on: 
 11.33     (1) the number of persons to whom the county board expects 
 11.34  to provide consumer supports grants; 
 11.35     (2) their eligibility for current program and services; 
 11.36     (3) the amount of nonfederal dollars expended on those 
 12.1   individuals for those programs and services or, in situations 
 12.2   where an individual is unable to obtain the support needed from 
 12.3   the program of origination due to the unavailability of service 
 12.4   providers at the time or the location where the supports are 
 12.5   needed, the allocation will be based on the county's best 
 12.6   estimate of the nonfederal dollars that would have been expended 
 12.7   if the services had been available; and 
 12.8      (4) projected dates when persons will start receiving 
 12.9   grants.  County allocations shall be adjusted periodically by 
 12.10  the commissioner based on the actual transfer of persons or 
 12.11  service openings, and the nonfederal dollars associated with 
 12.12  those persons or service openings, to the consumer support grant 
 12.13  program. 
 12.14     (c) The amount of funds transferred by the commissioner 
 12.15  from the alternative care account and the medical assistance 
 12.16  account for an individual may be changed if it is determined by 
 12.17  the county or its agent that the individual's need for support 
 12.18  has changed. 
 12.19     (d) The authority to utilize funds transferred to the 
 12.20  consumer support grant account for the purposes of implementing 
 12.21  and administering the consumer support grant program will not be 
 12.22  limited or constrained by the spending authority provided to the 
 12.23  program of origination. 
 12.24     (e) The commissioner shall may use up to five percent of 
 12.25  each county's allocation, as adjusted, for payments to that 
 12.26  county for administrative expenses, to be paid as a 
 12.27  proportionate addition to reported direct service expenditures. 
 12.28     (f) Except as provided in this paragraph, the county 
 12.29  allocation for each individual or individual's family cannot 
 12.30  exceed 80 percent of the total nonfederal dollars expended on 
 12.31  the individual by the program of origination except for the 
 12.32  developmental disabilities family support grant program which 
 12.33  can be approved up to 100 percent of the nonfederal dollars and 
 12.34  in situations as described in paragraph (b), clause (3).  In 
 12.35  situations where exceptional need exists or the individual's 
 12.36  need for support increases, up to 100 percent of the nonfederal 
 13.1   dollars expended by the consumer's program of origination may be 
 13.2   allocated to the county.  Allocations that exceed 80 percent of 
 13.3   the nonfederal dollars expended on the individual by the program 
 13.4   of origination must be approved by the commissioner.  The 
 13.5   remainder of the amount expended on the individual by the 
 13.6   program of origination will be used in the following 
 13.7   proportions:  half will be made available to the consumer 
 13.8   support grant program and participating counties for consumer 
 13.9   training, resource development, and other costs, and half will 
 13.10  be returned to the state general fund. 
 13.11     (g) The commissioner may recover, suspend, or withhold 
 13.12  payments if the county board, local agency, or grantee does not 
 13.13  comply with the requirements of this section. 
 13.14     (h) Grant funds unexpended by consumers shall return to the 
 13.15  state once a year.  The annual return of unexpended grant funds 
 13.16  shall occur in the quarter following the end of the state fiscal 
 13.17  year. 
 13.18     Sec. 12.  Minnesota Statutes 2000, section 256.476, 
 13.19  subdivision 8, is amended to read: 
 13.20     Subd. 8.  [COMMISSIONER RESPONSIBILITIES.] The commissioner 
 13.21  shall: 
 13.22     (1) transfer and allocate funds pursuant to this section; 
 13.23     (2) determine allocations based on projected and actual 
 13.24  local agency use; 
 13.25     (3) monitor and oversee overall program spending; 
 13.26     (4) evaluate the effectiveness of the program; 
 13.27     (5) provide training and technical assistance for local 
 13.28  agencies and consumers to help identify potential applicants to 
 13.29  the program; and 
 13.30     (6) develop guidelines for local agency program 
 13.31  administration and consumer information; and 
 13.32     (7) apply for a federal waiver or take any other action 
 13.33  necessary to maximize federal funding for the program by 
 13.34  September 1, 1999. 
 13.35     Sec. 13.  Minnesota Statutes 2000, section 256B.0625, 
 13.36  subdivision 7, is amended to read: 
 14.1      Subd. 7.  [PRIVATE DUTY NURSING.] Medical assistance covers 
 14.2   private duty nursing services in a recipient's home.  Recipients 
 14.3   who are authorized to receive private duty nursing services in 
 14.4   their home may use approved hours outside of the home during 
 14.5   hours when normal life activities take them outside of their 
 14.6   home and when, without the provision of private duty nursing, 
 14.7   their health and safety would be jeopardized.  To use private 
 14.8   duty nursing services at school, the recipient or responsible 
 14.9   party must provide written authorization in the care plan 
 14.10  identifying the chosen provider and the daily amount of services 
 14.11  to be used at school.  Medical assistance does not cover private 
 14.12  duty nursing services for residents of a hospital, nursing 
 14.13  facility, intermediate care facility, or a health care facility 
 14.14  licensed by the commissioner of health, except as authorized in 
 14.15  section 256B.64 for ventilator-dependent recipients in hospitals 
 14.16  or unless a resident who is otherwise eligible is on leave from 
 14.17  the facility and the facility either pays for the private duty 
 14.18  nursing services or forgoes the facility per diem for the leave 
 14.19  days that private duty nursing services are used.  Total hours 
 14.20  of service and payment allowed for services outside the home 
 14.21  cannot exceed that which is otherwise allowed in an in-home 
 14.22  setting according to section 256B.0627.  All private duty 
 14.23  nursing services must be provided according to the limits 
 14.24  established under section 256B.0627.  Private duty nursing 
 14.25  services may not be reimbursed if the nurse is the spouse of the 
 14.26  recipient or the parent or foster care provider of a recipient 
 14.27  who is under age 18, or the recipient's legal guardian. 
 14.28     Sec. 14.  Minnesota Statutes 2000, section 256B.0625, 
 14.29  subdivision 19a, is amended to read: 
 14.30     Subd. 19a.  [PERSONAL CARE ASSISTANT SERVICES.] Medical 
 14.31  assistance covers personal care assistant services in a 
 14.32  recipient's home.  To qualify for personal care assistant 
 14.33  services, recipients or responsible parties must be able to 
 14.34  identify the recipient's needs, direct and evaluate task 
 14.35  accomplishment, and provide for health and safety.  Approved 
 14.36  hours may be used outside the home when normal life activities 
 15.1   take them outside the home and when, without the provision of 
 15.2   personal care, their health and safety would be jeopardized.  To 
 15.3   use personal care assistant services at school, the recipient or 
 15.4   responsible party must provide written authorization in the care 
 15.5   plan identifying the chosen provider and the daily amount of 
 15.6   services to be used at school.  Total hours for services, 
 15.7   whether actually performed inside or outside the recipient's 
 15.8   home, cannot exceed that which is otherwise allowed for personal 
 15.9   care assistant services in an in-home setting according to 
 15.10  section 256B.0627.  Medical assistance does not cover personal 
 15.11  care assistant services for residents of a hospital, nursing 
 15.12  facility, intermediate care facility, health care facility 
 15.13  licensed by the commissioner of health, or unless a resident who 
 15.14  is otherwise eligible is on leave from the facility and the 
 15.15  facility either pays for the personal care assistant services or 
 15.16  forgoes the facility per diem for the leave days that personal 
 15.17  care assistant services are used.  All personal care assistant 
 15.18  services must be provided according to section 256B.0627.  
 15.19  Personal care assistant services may not be reimbursed if the 
 15.20  personal care assistant is the spouse or legal guardian of the 
 15.21  recipient or the parent of a recipient under age 18, or the 
 15.22  responsible party or the foster care provider of a recipient who 
 15.23  cannot direct the recipient's own care unless, in the case of a 
 15.24  foster care provider, a county or state case manager visits the 
 15.25  recipient as needed, but not less than every six months, to 
 15.26  monitor the health and safety of the recipient and to ensure the 
 15.27  goals of the care plan are met.  Parents of adult recipients, 
 15.28  adult children of the recipient or adult siblings of the 
 15.29  recipient may be reimbursed for personal care assistant services 
 15.30  if they are not the recipient's legal guardian and, if they are 
 15.31  granted a waiver under section 256B.0627.  Until July 1, 2001, 
 15.32  and Notwithstanding the provisions of section 256B.0627, 
 15.33  subdivision 4, paragraph (b), clause (4), the noncorporate legal 
 15.34  guardian or conservator of an adult, who is not the responsible 
 15.35  party and not the personal care provider organization, may be 
 15.36  granted a hardship waiver under section 256B.0627, to be 
 16.1   reimbursed to provide personal care assistant services to the 
 16.2   recipient, and shall not be considered to have a service 
 16.3   provider interest for purposes of participation on the screening 
 16.4   team under section 256B.092, subdivision 7. 
 16.5      Sec. 15.  Minnesota Statutes 2000, section 256B.0625, 
 16.6   subdivision 19c, is amended to read: 
 16.7      Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
 16.8   personal care assistant services provided by an individual who 
 16.9   is qualified to provide the services according to subdivision 
 16.10  19a and section 256B.0627, where the services are prescribed by 
 16.11  a physician in accordance with a plan of treatment and are 
 16.12  supervised by the recipient under the fiscal agent option 
 16.13  according to section 256B.0627, subdivision 10, or a qualified 
 16.14  professional.  "Qualified professional" means a mental health 
 16.15  professional as defined in section 245.462, subdivision 18, or 
 16.16  245.4871, subdivision 27; or a registered nurse as defined in 
 16.17  sections 148.171 to 148.285.  As part of the assessment, the 
 16.18  county public health nurse will consult with assist the 
 16.19  recipient or responsible party and to identify the most 
 16.20  appropriate person to provide supervision of the personal care 
 16.21  assistant.  The qualified professional shall perform the duties 
 16.22  described in Minnesota Rules, part 9505.0335, subpart 4.  
 16.23     Sec. 16.  Minnesota Statutes 2000, section 256B.0625, 
 16.24  subdivision 20, is amended to read: 
 16.25     Subd. 20.  [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 
 16.26  extent authorized by rule of the state agency, medical 
 16.27  assistance covers case management services to persons with 
 16.28  serious and persistent mental illness and children with severe 
 16.29  emotional disturbance.  Services provided under this section 
 16.30  must meet the relevant standards in sections 245.461 to 
 16.31  245.4888, the Comprehensive Adult and Children's Mental Health 
 16.32  Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 
 16.33  9505.0322, excluding subpart 10. 
 16.34     (b) Entities meeting program standards set out in rules 
 16.35  governing family community support services as defined in 
 16.36  section 245.4871, subdivision 17, are eligible for medical 
 17.1   assistance reimbursement for case management services for 
 17.2   children with severe emotional disturbance when these services 
 17.3   meet the program standards in Minnesota Rules, parts 9520.0900 
 17.4   to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 
 17.5      (c) Medical assistance and MinnesotaCare payment for mental 
 17.6   health case management shall be made on a monthly basis.  In 
 17.7   order to receive payment for an eligible child, the provider 
 17.8   must document at least a face-to-face contact with the child, 
 17.9   the child's parents, or the child's legal representative.  To 
 17.10  receive payment for an eligible adult, the provider must 
 17.11  document: 
 17.12     (1) at least a face-to-face contact with the adult or the 
 17.13  adult's legal representative; or 
 17.14     (2) at least a telephone contact with the adult or the 
 17.15  adult's legal representative and document a face-to-face contact 
 17.16  with the adult or the adult's legal representative within the 
 17.17  preceding two months. 
 17.18     (d) Payment for mental health case management provided by 
 17.19  county or state staff shall be based on the monthly rate 
 17.20  methodology under section 256B.094, subdivision 6, paragraph 
 17.21  (b), with separate rates calculated for child welfare and mental 
 17.22  health, and within mental health, separate rates for children 
 17.23  and adults. 
 17.24     (e) Payment for mental health case management provided by 
 17.25  county-contracted vendors shall be based on a monthly rate 
 17.26  negotiated by the host county.  The negotiated rate must not 
 17.27  exceed the rate charged by the vendor for the same service to 
 17.28  other payers.  If the service is provided by a team of 
 17.29  contracted vendors, the county may negotiate a team rate with a 
 17.30  vendor who is a member of the team.  The team shall determine 
 17.31  how to distribute the rate among its members.  No reimbursement 
 17.32  received by contracted vendors shall be returned to the county, 
 17.33  except to reimburse the county for advance funding provided by 
 17.34  the county to the vendor. 
 17.35     (f) If the service is provided by a team which includes 
 17.36  contracted vendors and county or state staff, the costs for 
 18.1   county or state staff participation in the team shall be 
 18.2   included in the rate for county-provided services.  In this 
 18.3   case, the contracted vendor and the county may each receive 
 18.4   separate payment for services provided by each entity in the 
 18.5   same month.  In order to prevent duplication of services, the 
 18.6   county must document, in the recipient's file, the need for team 
 18.7   case management and a description of the roles of the team 
 18.8   members. 
 18.9      (g) The commissioner shall calculate the nonfederal share 
 18.10  of actual medical assistance and general assistance medical care 
 18.11  payments for each county, based on the higher of calendar year 
 18.12  1995 or 1996, by service date, project that amount forward to 
 18.13  1999, and transfer one-half of the result from medical 
 18.14  assistance and general assistance medical care to each county's 
 18.15  mental health grants under sections 245.4886 and 256E.12 for 
 18.16  calendar year 1999.  The annualized minimum amount added to each 
 18.17  county's mental health grant shall be $3,000 per year for 
 18.18  children and $5,000 per year for adults.  The commissioner may 
 18.19  reduce the statewide growth factor in order to fund these 
 18.20  minimums.  The annualized total amount transferred shall become 
 18.21  part of the base for future mental health grants for each county.
 18.22     (h) Any net increase in revenue to the county as a result 
 18.23  of the change in this section must be used to provide expanded 
 18.24  mental health services as defined in sections 245.461 to 
 18.25  245.4888, the Comprehensive Adult and Children's Mental Health 
 18.26  Acts, excluding inpatient and residential treatment.  For 
 18.27  adults, increased revenue may also be used for services and 
 18.28  consumer supports which are part of adult mental health projects 
 18.29  approved under Laws 1997, chapter 203, article 7, section 25.  
 18.30  For children, increased revenue may also be used for respite 
 18.31  care and nonresidential individualized rehabilitation services 
 18.32  as defined in section 245.492, subdivisions 17 and 23.  
 18.33  "Increased revenue" has the meaning given in Minnesota Rules, 
 18.34  part 9520.0903, subpart 3.  
 18.35     (i) Notwithstanding section 256B.19, subdivision 1, the 
 18.36  nonfederal share of costs for mental health case management 
 19.1   shall be provided by the recipient's county of responsibility, 
 19.2   as defined in sections 256G.01 to 256G.12, from sources other 
 19.3   than federal funds or funds used to match other federal funds.  
 19.4      (j) The commissioner may suspend, reduce, or terminate the 
 19.5   reimbursement to a provider that does not meet the reporting or 
 19.6   other requirements of this section.  The county of 
 19.7   responsibility, as defined in sections 256G.01 to 256G.12, is 
 19.8   responsible for any federal disallowances.  The county may share 
 19.9   this responsibility with its contracted vendors.  
 19.10     (k) The commissioner shall set aside a portion of the 
 19.11  federal funds earned under this section to repay the special 
 19.12  revenue maximization account under section 256.01, subdivision 
 19.13  2, clause (15).  The repayment is limited to: 
 19.14     (1) the costs of developing and implementing this section; 
 19.15  and 
 19.16     (2) programming the information systems. 
 19.17     (l) Notwithstanding section 256.025, subdivision 2, 
 19.18  payments to counties for case management expenditures under this 
 19.19  section shall only be made from federal earnings from services 
 19.20  provided under this section.  Payments to contracted vendors 
 19.21  shall include both the federal earnings and the county share. 
 19.22     (m) Notwithstanding section 256B.041, county payments for 
 19.23  the cost of mental health case management services provided by 
 19.24  county or state staff shall not be made to the state treasurer.  
 19.25  For the purposes of mental health case management services 
 19.26  provided by county or state staff under this section, the 
 19.27  centralized disbursement of payments to counties under section 
 19.28  256B.041 consists only of federal earnings from services 
 19.29  provided under this section. 
 19.30     (n) Case management services under this subdivision do not 
 19.31  include therapy, treatment, legal, or outreach services. 
 19.32     (o) If the recipient is a resident of a nursing facility, 
 19.33  intermediate care facility, or hospital, and the recipient's 
 19.34  institutional care is paid by medical assistance, payment for 
 19.35  case management services under this subdivision is limited to 
 19.36  the last 30 180 days of the recipient's residency in that 
 20.1   facility and may not exceed more than two six months in a 
 20.2   calendar year. 
 20.3      (p) Payment for case management services under this 
 20.4   subdivision shall not duplicate payments made under other 
 20.5   program authorities for the same purpose. 
 20.6      (q) By July 1, 2000, the commissioner shall evaluate the 
 20.7   effectiveness of the changes required by this section, including 
 20.8   changes in number of persons receiving mental health case 
 20.9   management, changes in hours of service per person, and changes 
 20.10  in caseload size. 
 20.11     (r) For each calendar year beginning with the calendar year 
 20.12  2001, the annualized amount of state funds for each county 
 20.13  determined under paragraph (g) shall be adjusted by the county's 
 20.14  percentage change in the average number of clients per month who 
 20.15  received case management under this section during the fiscal 
 20.16  year that ended six months prior to the calendar year in 
 20.17  question, in comparison to the prior fiscal year. 
 20.18     (s) For counties receiving the minimum allocation of $3,000 
 20.19  or $5,000 described in paragraph (g), the adjustment in 
 20.20  paragraph (r) shall be determined so that the county receives 
 20.21  the higher of the following amounts: 
 20.22     (1) a continuation of the minimum allocation in paragraph 
 20.23  (g); or 
 20.24     (2) an amount based on that county's average number of 
 20.25  clients per month who received case management under this 
 20.26  section during the fiscal year that ended six months prior to 
 20.27  the calendar year in question, in comparison to the prior fiscal 
 20.28  year, times the average statewide grant per person per month for 
 20.29  counties not receiving the minimum allocation. 
 20.30     (t) The adjustments in paragraphs (r) and (s) shall be 
 20.31  calculated separately for children and adults. 
 20.32     Sec. 17.  Minnesota Statutes 2000, section 256B.0625, is 
 20.33  amended by adding a subdivision to read: 
 20.34     Subd. 43.  [TARGETED CASE MANAGEMENT.] For purposes of 
 20.35  subdivisions 43a to 43h, the following terms have the meanings 
 20.36  given them: 
 21.1      (1) "home care service recipients" means those individuals 
 21.2   receiving the following services under section 256B.0627:  
 21.3   skilled nursing visits, home health aide visits, private duty 
 21.4   nursing, personal care assistants, or therapies provided through 
 21.5   a home health agency; 
 21.6      (2) "home care targeted case management" means the 
 21.7   provision of targeted case management services for the purpose 
 21.8   of assisting home care service recipients to gain access to 
 21.9   needed services and supports so that they may remain in the 
 21.10  community; 
 21.11     (3) "institutions" means hospitals, consistent with Code of 
 21.12  Federal Regulations, title 42, section 440.10; regional 
 21.13  treatment center inpatient services, consistent with section 
 21.14  245.474; nursing facilities; and intermediate care facilities 
 21.15  for persons with mental retardation; 
 21.16     (4) "relocation targeted case management" means the 
 21.17  provision of targeted case management services for the purpose 
 21.18  of assisting recipients to gain access to needed services and 
 21.19  supports if they choose to move from an institution to the 
 21.20  community.  Relocation targeted case management may be provided 
 21.21  during the last 180 consecutive days of an eligible recipient's 
 21.22  institutional stay; and 
 21.23     (5) "targeted case management" means case management 
 21.24  services provided to help recipients gain access to needed 
 21.25  medical, social, educational, and other services and supports. 
 21.26     Sec. 18.  Minnesota Statutes 2000, section 256B.0625, is 
 21.27  amended by adding a subdivision to read: 
 21.28     Subd. 43a.  [ELIGIBILITY.] The following persons are 
 21.29  eligible for relocation targeted case management or home care 
 21.30  targeted case management: 
 21.31     (1) medical assistance eligible persons residing in 
 21.32  institutions who choose to move into the community are eligible 
 21.33  for relocation case management services; and 
 21.34     (2) medical assistance eligible persons receiving home care 
 21.35  services, who are not eligible for any other medical assistance 
 21.36  reimbursable case management service, are eligible for home care 
 22.1   targeted case management services beginning January 1, 2003.  
 22.2      Sec. 19.  Minnesota Statutes 2000, section 256B.0625, is 
 22.3   amended by adding a subdivision to read: 
 22.4      Subd. 43b.  [RELOCATION CASE MANAGER PROVIDER 
 22.5   QUALIFICATIONS.] The following qualifications and certification 
 22.6   standards must be met by providers of relocation targeted case 
 22.7   management: 
 22.8      (a) The commissioner must certify each provider or 
 22.9   relocation targeted case management before enrollment.  The 
 22.10  certification process shall examine the provider's ability to 
 22.11  meet the requirements in this subdivision and other federal and 
 22.12  state requirements of this service.  A certified targeted case 
 22.13  management provider may subcontract with another provider to 
 22.14  deliver targeted case management services.  Subcontracted 
 22.15  providers must demonstrate the ability to provide the services 
 22.16  outlined in subdivision 43d. 
 22.17     (b) A relocation targeted case management provider is an 
 22.18  enrolled medical assistance provider who is determined by the 
 22.19  commissioner to have all of the following characteristics: 
 22.20     (1) the legal authority to provide public welfare under 
 22.21  sections 393.01, subdivision 7; and 393.07; or a federally 
 22.22  recognized Indian tribe; 
 22.23     (2) the demonstrated capacity and experience to provide the 
 22.24  components of case management to coordinate and link community 
 22.25  resources needed by the eligible population; 
 22.26     (3) the administrative capacity and experience to serve the 
 22.27  target population for whom it will provide services and ensure 
 22.28  quality of services under state and federal requirements; 
 22.29     (4) the legal authority to provide complete investigative 
 22.30  and protective services under section 626.556, subdivision 10; 
 22.31  and child welfare and foster care services under section 393.07, 
 22.32  subdivisions 1 and 2; or a federally recognized Indian tribe; 
 22.33     (5) a financial management system that provides accurate 
 22.34  documentation of services and costs under state and federal 
 22.35  requirements; and 
 22.36     (6) the capacity to document and maintain individual case 
 23.1   records under state and federal requirements. 
 23.2   A provider of targeted case management under subdivision 20 may 
 23.3   be deemed a certified provider of relocation targeted case 
 23.4   management. 
 23.5      Sec. 20.  Minnesota Statutes 2000, section 256B.0625, is 
 23.6   amended by adding a subdivision to read: 
 23.7      Subd. 43c.  [HOME CARE CASE MANAGER PROVIDER 
 23.8   QUALIFICATIONS.] The following qualifications and certification 
 23.9   standards must be met by providers of home care targeted case 
 23.10  management. 
 23.11     (a) The commissioner must certify each provider of home 
 23.12  care targeted case management before enrollment.  The 
 23.13  certification process shall examine the provider's ability to 
 23.14  meet the requirements in this subdivision and other state and 
 23.15  federal requirements of this service. 
 23.16     (b) A home care targeted case management provider is an 
 23.17  enrolled medical assistance provider who has a minimum of a 
 23.18  bachelor's degree, a license in a health or human services 
 23.19  field, and is determined by the commissioner to have all of the 
 23.20  following characteristics: 
 23.21     (1) the demonstrated capacity and experience to provide the 
 23.22  components of case management to coordinate and link community 
 23.23  resources needed by the eligible population; 
 23.24     (2) the administrative capacity and experience to serve the 
 23.25  target population for whom it will provide services and ensure 
 23.26  quality of services under state and federal requirements; 
 23.27     (3) a financial management system that provides accurate 
 23.28  documentation of services and costs under state and federal 
 23.29  requirements; 
 23.30     (4) the capacity to document and maintain individual case 
 23.31  records under state and federal requirements; and 
 23.32     (5) the capacity to coordinate with county administrative 
 23.33  functions. 
 23.34     Sec. 21.  Minnesota Statutes 2000, section 256B.0625, is 
 23.35  amended by adding a subdivision to read: 
 23.36     Subd. 43d.  [ELIGIBLE SERVICES.] Services eligible for 
 24.1   medical assistance reimbursement as targeted case management 
 24.2   include: 
 24.3      (1) assessment of the recipient's need for targeted case 
 24.4   management services; 
 24.5      (2) development, completion, and regular review of a 
 24.6   written individual service plan, which is based upon the 
 24.7   assessment of the recipient's needs and choices, and which will 
 24.8   ensure access to medical, social, educational, and other related 
 24.9   services and supports; 
 24.10     (3) routine contact or communication with the recipient, 
 24.11  the recipient's family, primary caregiver, legal representative, 
 24.12  substitute care provider, service providers, or other relevant 
 24.13  persons identified as necessary to the development or 
 24.14  implementation of the goals of the individual service plan; 
 24.15     (4) coordinating referrals for, and the provision of, case 
 24.16  management services for the recipient with appropriate service 
 24.17  providers, consistent with section 1902(a)(23) of the Social 
 24.18  Security Act; 
 24.19     (5) coordinating and monitoring the overall service 
 24.20  delivery to ensure quality of services, appropriateness, and 
 24.21  continued need; 
 24.22     (6) completing and maintaining necessary documentation that 
 24.23  supports and verifies the activities in this subdivision; 
 24.24     (7) traveling to conduct a visit with the recipient or 
 24.25  other relevant person necessary to develop or implement the 
 24.26  goals of the individual service plan; and 
 24.27     (8) coordinating with the institution discharge planner in 
 24.28  the 180-day period before the recipient's discharge. 
 24.29     Sec. 22.  Minnesota Statutes 2000, section 256B.0625, is 
 24.30  amended by adding a subdivision to read: 
 24.31     Subd. 43e.  [TIMELINES.] The following timelines must be 
 24.32  met for assigning a case manager: 
 24.33     (1) for relocation targeted case management, an eligible 
 24.34  recipient must be assigned a case manager who visits the person 
 24.35  within 20 working days of requesting one from their county of 
 24.36  financial responsibility as determined under chapter 256G.  If a 
 25.1   county agency does not provide case management services as 
 25.2   required, the recipient may, after written notice to the county 
 25.3   agency, obtain targeted relocation case management services from 
 25.4   a home care targeted case management provider under this 
 25.5   subdivision; and 
 25.6      (2) for home care targeted case management, an eligible 
 25.7   recipient must be assigned a case manager within 20 working days 
 25.8   of requesting one from a home care targeted case management 
 25.9   provider, as defined in subdivision 43c. 
 25.10     Sec. 23.  Minnesota Statutes 2000, section 256B.0625, is 
 25.11  amended by adding a subdivision to read: 
 25.12     Subd. 43f.  [EVALUATION.] The commissioner shall evaluate 
 25.13  the delivery of targeted case management, including, but not 
 25.14  limited to, access to case management services, consumer 
 25.15  satisfaction with case management services, and quality of case 
 25.16  management services. 
 25.17     Sec. 24.  Minnesota Statutes 2000, section 256B.0625, is 
 25.18  amended by adding a subdivision to read: 
 25.19     Subd. 43g.  [CONTACT DOCUMENTATION.] The case manager must 
 25.20  document each face-to-face and telephone contact with the 
 25.21  recipient and others involved in the recipient's individual 
 25.22  service plan. 
 25.23     Sec. 25.  Minnesota Statutes 2000, section 256B.0625, is 
 25.24  amended by adding a subdivision to read: 
 25.25     Subd. 43h.  [PAYMENT RATES.] The commissioner shall set 
 25.26  payment rates for targeted case management under this 
 25.27  subdivision.  Case managers may bill according to the following 
 25.28  criteria: 
 25.29     (1) for relocation targeted case management, case managers 
 25.30  may bill for direct case management activities, including 
 25.31  face-to-face and telephone contacts, in the 180 days preceding 
 25.32  an eligible recipient's discharge from an institution; and 
 25.33     (2) for home care targeted case management, case managers 
 25.34  may bill for direct case management activities, including 
 25.35  face-to-face and telephone contacts. 
 25.36     Sec. 26.  Minnesota Statutes 2000, section 256B.0627, 
 26.1   subdivision 1, is amended to read: 
 26.2      Subdivision 1.  [DEFINITION.] (a) "Activities of daily 
 26.3   living" includes eating, toileting, grooming, dressing, bathing, 
 26.4   transferring, mobility, and positioning.  
 26.5      (b) "Assessment" means a review and evaluation of a 
 26.6   recipient's need for home care services conducted in person.  
 26.7   Assessments for private duty nursing shall be conducted by a 
 26.8   registered private duty nurse.  Assessments for home health 
 26.9   agency services shall be conducted by a home health agency 
 26.10  nurse.  Assessments for personal care assistant services shall 
 26.11  be conducted by the county public health nurse or a certified 
 26.12  public health nurse under contract with the county.  A 
 26.13  face-to-face assessment must include:  documentation of health 
 26.14  status, determination of need, evaluation of service 
 26.15  effectiveness, identification of appropriate services, service 
 26.16  plan development or modification, coordination of services, 
 26.17  referrals and follow-up to appropriate payers and community 
 26.18  resources, completion of required reports, recommendation of 
 26.19  service authorization, and consumer education.  Once the need 
 26.20  for personal care assistant services is determined under this 
 26.21  section, the county public health nurse or certified public 
 26.22  health nurse under contract with the county is responsible for 
 26.23  communicating this recommendation to the commissioner and the 
 26.24  recipient.  A face-to-face assessment for personal 
 26.25  care assistant services is conducted on those recipients who 
 26.26  have never had a county public health nurse assessment.  A 
 26.27  face-to-face assessment must occur at least annually or when 
 26.28  there is a significant change in the recipient's condition or 
 26.29  when there is a change in the need for personal care assistant 
 26.30  services.  A service update may substitute for the annual 
 26.31  face-to-face assessment when there is not a significant change 
 26.32  in recipient condition or a change in the need for personal care 
 26.33  assistant service.  A service update or review for temporary 
 26.34  increase includes a review of initial baseline data, evaluation 
 26.35  of service effectiveness, redetermination of service need, 
 26.36  modification of service plan and appropriate referrals, update 
 27.1   of initial forms, obtaining service authorization, and on going 
 27.2   consumer education.  Assessments for medical assistance home 
 27.3   care services for mental retardation or related conditions and 
 27.4   alternative care services for developmentally disabled home and 
 27.5   community-based waivered recipients may be conducted by the 
 27.6   county public health nurse to ensure coordination and avoid 
 27.7   duplication.  Assessments must be completed on forms provided by 
 27.8   the commissioner within 30 days of a request for home care 
 27.9   services by a recipient or responsible party. 
 27.10     (b) (c) "Care plan" means a written description of personal 
 27.11  care assistant services developed by the qualified 
 27.12  professional or the recipient's physician with the recipient or 
 27.13  responsible party to be used by the personal care assistant with 
 27.14  a copy provided to the recipient or responsible party. 
 27.15     (d) "Complex and regular private duty nursing care" means: 
 27.16     (1) complex care is private duty nursing provided to 
 27.17  recipients who are ventilator dependent or for whom a physician 
 27.18  has certified that were it not for private duty nursing the 
 27.19  recipient would meet the criteria for inpatient hospital 
 27.20  intensive care unit (ICU) level of care; and 
 27.21     (2) regular care is private duty nursing provided to all 
 27.22  other recipients. 
 27.23     (e) "Health-related functions" means functions that can be 
 27.24  delegated or assigned by a licensed health care professional 
 27.25  under state law to be performed by a personal care attendant. 
 27.26     (c) (f) "Home care services" means a health service, 
 27.27  determined by the commissioner as medically necessary, that is 
 27.28  ordered by a physician and documented in a service plan that is 
 27.29  reviewed by the physician at least once every 62 60 days for the 
 27.30  provision of home health services, or private duty nursing, or 
 27.31  at least once every 365 days for personal care.  Home care 
 27.32  services are provided to the recipient at the recipient's 
 27.33  residence that is a place other than a hospital or long-term 
 27.34  care facility or as specified in section 256B.0625.  
 27.35     (g) "Instrumental activities of daily living" includes meal 
 27.36  planning and preparation, managing finances, shopping for food, 
 28.1   clothing, and other essential items, performing essential 
 28.2   household chores, communication by telephone and other media, 
 28.3   and getting around and participating in the community. 
 28.4      (d) (h) "Medically necessary" has the meaning given in 
 28.5   Minnesota Rules, parts 9505.0170 to 9505.0475.  
 28.6      (e) (i) "Personal care assistant" means a person who:  
 28.7      (1) is at least 18 years old, except for persons 16 to 18 
 28.8   years of age who participated in a related school-based job 
 28.9   training program or have completed a certified home health aide 
 28.10  competency evaluation; 
 28.11     (2) is able to effectively communicate with the recipient 
 28.12  and personal care provider organization; 
 28.13     (3) effective July 1, 1996, has completed one of the 
 28.14  training requirements as specified in Minnesota Rules, part 
 28.15  9505.0335, subpart 3, items A to D; 
 28.16     (4) has the ability to, and provides covered personal 
 28.17  care assistant services according to the recipient's care plan, 
 28.18  responds appropriately to recipient needs, and reports changes 
 28.19  in the recipient's condition to the supervising qualified 
 28.20  professional or physician; 
 28.21     (5) is not a consumer of personal care assistant services; 
 28.22  and 
 28.23     (6) is subject to criminal background checks and procedures 
 28.24  specified in section 245A.04.  
 28.25     (f) (j) "Personal care provider organization" means an 
 28.26  organization enrolled to provide personal care assistant 
 28.27  services under the medical assistance program that complies with 
 28.28  the following:  (1) owners who have a five percent interest or 
 28.29  more, and managerial officials are subject to a background study 
 28.30  as provided in section 245A.04.  This applies to currently 
 28.31  enrolled personal care provider organizations and those agencies 
 28.32  seeking enrollment as a personal care provider organization.  An 
 28.33  organization will be barred from enrollment if an owner or 
 28.34  managerial official of the organization has been convicted of a 
 28.35  crime specified in section 245A.04, or a comparable crime in 
 28.36  another jurisdiction, unless the owner or managerial official 
 29.1   meets the reconsideration criteria specified in section 245A.04; 
 29.2   (2) the organization must maintain a surety bond and liability 
 29.3   insurance throughout the duration of enrollment and provides 
 29.4   proof thereof.  The insurer must notify the department of human 
 29.5   services of the cancellation or lapse of policy; and (3) the 
 29.6   organization must maintain documentation of services as 
 29.7   specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
 29.8   as evidence of compliance with personal care assistant training 
 29.9   requirements. 
 29.10     (g) (k) "Responsible party" means an individual residing 
 29.11  with a recipient of personal care assistant services who is 
 29.12  capable of providing the supportive care necessary to assist the 
 29.13  recipient to live in the community, is at least 18 years old, 
 29.14  and is not a personal care assistant.  Responsible parties who 
 29.15  are parents of minors or guardians of minors or incapacitated 
 29.16  persons may delegate the responsibility to another adult during 
 29.17  a temporary absence of at least 24 hours but not more than six 
 29.18  months.  The person delegated as a responsible party must be 
 29.19  able to meet the definition of responsible party, except that 
 29.20  the delegated responsible party is required to reside with the 
 29.21  recipient only while serving as the responsible party.  Foster 
 29.22  care license holders may be designated the responsible party for 
 29.23  residents of the foster care home if case management is provided 
 29.24  as required in section 256B.0625, subdivision 19a.  For persons 
 29.25  who, as of April 1, 1992, are sharing personal care assistant 
 29.26  services in order to obtain the availability of 24-hour 
 29.27  coverage, an employee of the personal care provider organization 
 29.28  may be designated as the responsible party if case management is 
 29.29  provided as required in section 256B.0625, subdivision 19a. 
 29.30     (h) (l) "Service plan" means a written description of the 
 29.31  services needed based on the assessment developed by the nurse 
 29.32  who conducts the assessment together with the recipient or 
 29.33  responsible party.  The service plan shall include a description 
 29.34  of the covered home care services, frequency and duration of 
 29.35  services, and expected outcomes and goals.  The recipient and 
 29.36  the provider chosen by the recipient or responsible party must 
 30.1   be given a copy of the completed service plan within 30 calendar 
 30.2   days of the request for home care services by the recipient or 
 30.3   responsible party. 
 30.4      (i) (m) "Skilled nurse visits" are provided in a 
 30.5   recipient's residence under a plan of care or service plan that 
 30.6   specifies a level of care which the nurse is qualified to 
 30.7   provide.  These services are: 
 30.8      (1) nursing services according to the written plan of care 
 30.9   or service plan and accepted standards of medical and nursing 
 30.10  practice in accordance with chapter 148; 
 30.11     (2) services which due to the recipient's medical condition 
 30.12  may only be safely and effectively provided by a registered 
 30.13  nurse or a licensed practical nurse; 
 30.14     (3) assessments performed only by a registered nurse; and 
 30.15     (4) teaching and training the recipient, the recipient's 
 30.16  family, or other caregivers requiring the skills of a registered 
 30.17  nurse or licensed practical nurse. 
 30.18     (n) "Telehomecare" means the use of telecommunications 
 30.19  technology by a home health care professional to deliver home 
 30.20  health care services, within the professional's scope of 
 30.21  practice, to a patient located at a site other than the site 
 30.22  where the practitioner is located. 
 30.23     Sec. 27.  Minnesota Statutes 2000, section 256B.0627, 
 30.24  subdivision 2, is amended to read: 
 30.25     Subd. 2.  [SERVICES COVERED.] Home care services covered 
 30.26  under this section include:  
 30.27     (1) nursing services under section 256B.0625, subdivision 
 30.28  6a; 
 30.29     (2) private duty nursing services under section 256B.0625, 
 30.30  subdivision 7; 
 30.31     (3) home health aide services under section 256B.0625, 
 30.32  subdivision 6a; 
 30.33     (4) personal care assistant services under section 
 30.34  256B.0625, subdivision 19a; 
 30.35     (5) supervision of personal care assistant services 
 30.36  provided by a qualified professional under section 256B.0625, 
 31.1   subdivision 19a; 
 31.2      (6) consulting qualified professional of personal care 
 31.3   assistant services under the fiscal agent intermediary option as 
 31.4   specified in subdivision 10; 
 31.5      (7) face-to-face assessments by county public health nurses 
 31.6   for services under section 256B.0625, subdivision 19a; and 
 31.7      (8) service updates and review of temporary increases for 
 31.8   personal care assistant services by the county public health 
 31.9   nurse for services under section 256B.0625, subdivision 19a. 
 31.10     Sec. 28.  Minnesota Statutes 2000, section 256B.0627, 
 31.11  subdivision 4, is amended to read: 
 31.12     Subd. 4.  [PERSONAL CARE ASSISTANT SERVICES.] (a) The 
 31.13  personal care assistant services that are eligible for payment 
 31.14  are the following: services and supports furnished to an 
 31.15  individual, as needed, to assist in accomplishing activities of 
 31.16  daily living; instrumental activities of daily living; 
 31.17  health-related functions through hands-on assistance, 
 31.18  supervision, and cueing; and redirection and intervention for 
 31.19  behavior including observation and monitoring.  
 31.20     (b) Payment for services will be made within the limits 
 31.21  approved using the prior authorized process established in 
 31.22  subdivision 5. 
 31.23     (c) The amount and type of services authorized shall be 
 31.24  based on an assessment of the recipient's needs in these areas: 
 31.25     (1) bowel and bladder care; 
 31.26     (2) skin care to maintain the health of the skin; 
 31.27     (3) repetitive maintenance range of motion, muscle 
 31.28  strengthening exercises, and other tasks specific to maintaining 
 31.29  a recipient's optimal level of function; 
 31.30     (4) respiratory assistance; 
 31.31     (5) transfers and ambulation; 
 31.32     (6) bathing, grooming, and hairwashing necessary for 
 31.33  personal hygiene; 
 31.34     (7) turning and positioning; 
 31.35     (8) assistance with furnishing medication that is 
 31.36  self-administered; 
 32.1      (9) application and maintenance of prosthetics and 
 32.2   orthotics; 
 32.3      (10) cleaning medical equipment; 
 32.4      (11) dressing or undressing; 
 32.5      (12) assistance with eating and meal preparation and 
 32.6   necessary grocery shopping; 
 32.7      (13) accompanying a recipient to obtain medical diagnosis 
 32.8   or treatment; 
 32.9      (14) assisting, monitoring, or prompting the recipient to 
 32.10  complete the services in clauses (1) to (13); 
 32.11     (15) redirection, monitoring, and observation that are 
 32.12  medically necessary and an integral part of completing the 
 32.13  personal care assistant services described in clauses (1) to 
 32.14  (14); 
 32.15     (16) redirection and intervention for behavior, including 
 32.16  observation and monitoring; 
 32.17     (17) interventions for seizure disorders, including 
 32.18  monitoring and observation if the recipient has had a seizure 
 32.19  that requires intervention within the past three months; 
 32.20     (18) tracheostomy suctioning using a clean procedure if the 
 32.21  procedure is properly delegated by a registered nurse.  Before 
 32.22  this procedure can be delegated to a personal care assistant, a 
 32.23  registered nurse must determine that the tracheostomy suctioning 
 32.24  can be accomplished utilizing a clean rather than a sterile 
 32.25  procedure and must ensure that the personal care assistant has 
 32.26  been taught the proper procedure; and 
 32.27     (19) incidental household services that are an integral 
 32.28  part of a personal care service described in clauses (1) to (18).
 32.29  For purposes of this subdivision, monitoring and observation 
 32.30  means watching for outward visible signs that are likely to 
 32.31  occur and for which there is a covered personal care service or 
 32.32  an appropriate personal care intervention.  For purposes of this 
 32.33  subdivision, a clean procedure refers to a procedure that 
 32.34  reduces the numbers of microorganisms or prevents or reduces the 
 32.35  transmission of microorganisms from one person or place to 
 32.36  another.  A clean procedure may be used beginning 14 days after 
 33.1   insertion. 
 33.2      (b) (d) The personal care assistant services that are not 
 33.3   eligible for payment are the following:  
 33.4      (1) services not ordered by the physician; 
 33.5      (2) assessments by personal care assistant provider 
 33.6   organizations or by independently enrolled registered nurses; 
 33.7      (3) services that are not in the service plan; 
 33.8      (4) services provided by the recipient's spouse, legal 
 33.9   guardian for an adult or child recipient, or parent of a 
 33.10  recipient under age 18; 
 33.11     (5) services provided by a foster care provider of a 
 33.12  recipient who cannot direct the recipient's own care, unless 
 33.13  monitored by a county or state case manager under section 
 33.14  256B.0625, subdivision 19a; 
 33.15     (6) services provided by the residential or program license 
 33.16  holder in a residence for more than four persons; 
 33.17     (7) services that are the responsibility of a residential 
 33.18  or program license holder under the terms of a service agreement 
 33.19  and administrative rules; 
 33.20     (8) sterile procedures; 
 33.21     (9) injections of fluids into veins, muscles, or skin; 
 33.22     (10) (9) services provided by parents of adult recipients, 
 33.23  adult children, or siblings of the recipient, unless these 
 33.24  relatives meet one of the following hardship criteria and the 
 33.25  commissioner waives this requirement: 
 33.26     (i) the relative resigns from a part-time or full-time job 
 33.27  to provide personal care for the recipient; 
 33.28     (ii) the relative goes from a full-time to a part-time job 
 33.29  with less compensation to provide personal care for the 
 33.30  recipient; 
 33.31     (iii) the relative takes a leave of absence without pay to 
 33.32  provide personal care for the recipient; 
 33.33     (iv) the relative incurs substantial expenses by providing 
 33.34  personal care for the recipient; or 
 33.35     (v) because of labor conditions, special language needs, or 
 33.36  intermittent hours of care needed, the relative is needed in 
 34.1   order to provide an adequate number of qualified personal care 
 34.2   assistants to meet the medical needs of the recipient; 
 34.3      (11) (10) homemaker services that are not an integral part 
 34.4   of a personal care assistant services; 
 34.5      (12) (11) home maintenance, or chore services; 
 34.6      (13) (12) services not specified under paragraph (a); and 
 34.7      (14) (13) services not authorized by the commissioner or 
 34.8   the commissioner's designee. 
 34.9      (e) The recipient or responsible party may choose to 
 34.10  supervise the personal care assistant or to have a qualified 
 34.11  professional, as defined in section 256B.0625, subdivision 19c, 
 34.12  provide the supervision.  As required under section 256B.0625, 
 34.13  subdivision 19c, the county public health nurse, as a part of 
 34.14  the assessment, will consult with the recipient or responsible 
 34.15  party to identify the most appropriate person to provide 
 34.16  supervision of the personal care assistant.  Health-related 
 34.17  delegated tasks performed by the personal care assistant will be 
 34.18  under the supervision of a qualified professional or the 
 34.19  direction of the recipient's physician.  If the recipient has a 
 34.20  qualified professional, Minnesota Rules, part 9505.0335, subpart 
 34.21  4, applies. 
 34.22     Sec. 29.  Minnesota Statutes 2000, section 256B.0627, 
 34.23  subdivision 5, is amended to read: 
 34.24     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
 34.25  payments for home care services shall be limited according to 
 34.26  this subdivision.  
 34.27     (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
 34.28  recipient may receive the following home care services during a 
 34.29  calendar year: 
 34.30     (1) up to two face-to-face assessments to determine a 
 34.31  recipient's need for personal care assistant services; 
 34.32     (2) one service update done to determine a recipient's need 
 34.33  for personal care assistant services; and 
 34.34     (3) up to five nine skilled nurse visits.  
 34.35     (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
 34.36  services above the limits in paragraph (a) must receive the 
 35.1   commissioner's prior authorization, except when: 
 35.2      (1) the home care services were required to treat an 
 35.3   emergency medical condition that if not immediately treated 
 35.4   could cause a recipient serious physical or mental disability, 
 35.5   continuation of severe pain, or death.  The provider must 
 35.6   request retroactive authorization no later than five working 
 35.7   days after giving the initial service.  The provider must be 
 35.8   able to substantiate the emergency by documentation such as 
 35.9   reports, notes, and admission or discharge histories; 
 35.10     (2) the home care services were provided on or after the 
 35.11  date on which the recipient's eligibility began, but before the 
 35.12  date on which the recipient was notified that the case was 
 35.13  opened.  Authorization will be considered if the request is 
 35.14  submitted by the provider within 20 working days of the date the 
 35.15  recipient was notified that the case was opened; 
 35.16     (3) a third-party payor for home care services has denied 
 35.17  or adjusted a payment.  Authorization requests must be submitted 
 35.18  by the provider within 20 working days of the notice of denial 
 35.19  or adjustment.  A copy of the notice must be included with the 
 35.20  request; 
 35.21     (4) the commissioner has determined that a county or state 
 35.22  human services agency has made an error; or 
 35.23     (5) the professional nurse determines an immediate need for 
 35.24  up to 40 skilled nursing or home health aide visits per calendar 
 35.25  year and submits a request for authorization within 20 working 
 35.26  days of the initial service date, and medical assistance is 
 35.27  determined to be the appropriate payer. 
 35.28     (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
 35.29  authorization will be evaluated according to the same criteria 
 35.30  applied to prior authorization requests.  
 35.31     (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
 35.32  section 256B.0627, subdivision 1, paragraph (a), shall be 
 35.33  conducted initially, and at least annually thereafter, in person 
 35.34  with the recipient and result in a completed service plan using 
 35.35  forms specified by the commissioner.  Within 30 days of 
 35.36  recipient or responsible party request for home care services, 
 36.1   the assessment, the service plan, and other information 
 36.2   necessary to determine medical necessity such as diagnostic or 
 36.3   testing information, social or medical histories, and hospital 
 36.4   or facility discharge summaries shall be submitted to the 
 36.5   commissioner.  For personal care assistant services: 
 36.6      (1) The amount and type of service authorized based upon 
 36.7   the assessment and service plan will follow the recipient if the 
 36.8   recipient chooses to change providers.  
 36.9      (2) If the recipient's medical need changes, the 
 36.10  recipient's provider may assess the need for a change in service 
 36.11  authorization and request the change from the county public 
 36.12  health nurse.  Within 30 days of the request, the public health 
 36.13  nurse will determine whether to request the change in services 
 36.14  based upon the provider assessment, or conduct a home visit to 
 36.15  assess the need and determine whether the change is appropriate. 
 36.16     (3) To continue to receive personal care assistant services 
 36.17  after the first year, the recipient or the responsible party, in 
 36.18  conjunction with the public health nurse, may complete a service 
 36.19  update on forms developed by the commissioner according to 
 36.20  criteria and procedures in subdivision 1.  
 36.21     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
 36.22  commissioner's designee, shall review the assessment, service 
 36.23  update, request for temporary services, service plan, and any 
 36.24  additional information that is submitted.  The commissioner 
 36.25  shall, within 30 days after receiving a complete request, 
 36.26  assessment, and service plan, authorize home care services as 
 36.27  follows:  
 36.28     (1)  [HOME HEALTH SERVICES.] All home health services 
 36.29  provided by a licensed nurse or a home health aide must be prior 
 36.30  authorized by the commissioner or the commissioner's designee.  
 36.31  Prior authorization must be based on medical necessity and 
 36.32  cost-effectiveness when compared with other care options.  When 
 36.33  home health services are used in combination with personal care 
 36.34  and private duty nursing, the cost of all home care services 
 36.35  shall be considered for cost-effectiveness.  The commissioner 
 36.36  shall limit nurse and home health aide visits to no more than 
 37.1   one visit each per day. except that the commissioner, or the 
 37.2   commissioner's designee, may authorize up to two skilled nurse 
 37.3   visits or two home health aide visits per day, but not more than 
 37.4   a total of three visits per day for skilled nursing services and 
 37.5   home health aide services. 
 37.6      (2)  [PERSONAL CARE ASSISTANT SERVICES.] (i) All personal 
 37.7   care assistant services and supervision by a qualified 
 37.8   professional, if requested by the recipient, must be prior 
 37.9   authorized by the commissioner or the commissioner's designee 
 37.10  except for the assessments established in paragraph (a).  The 
 37.11  amount of personal care assistant services authorized must be 
 37.12  based on the recipient's home care rating.  A child may not be 
 37.13  found to be dependent in an activity of daily living if because 
 37.14  of the child's age an adult would either perform the activity 
 37.15  for the child or assist the child with the activity and the 
 37.16  amount of assistance needed is similar to the assistance 
 37.17  appropriate for a typical child of the same age.  Based on 
 37.18  medical necessity, the commissioner may authorize: 
 37.19     (A) up to two times the average number of direct care hours 
 37.20  provided in nursing facilities for the recipient's comparable 
 37.21  case mix level; or 
 37.22     (B) up to three times the average number of direct care 
 37.23  hours provided in nursing facilities for recipients who have 
 37.24  complex medical needs or are dependent in at least seven 
 37.25  activities of daily living and need physical assistance with 
 37.26  eating or have a neurological diagnosis; or 
 37.27     (C) up to 60 percent of the average reimbursement rate, as 
 37.28  of July 1, 1991, for care provided in a regional treatment 
 37.29  center for recipients who have Level I behavior, plus any 
 37.30  inflation adjustment as provided by the legislature for personal 
 37.31  care service; or 
 37.32     (D) up to the amount the commissioner would pay, as of July 
 37.33  1, 1991, plus any inflation adjustment provided for home care 
 37.34  services, for care provided in a regional treatment center for 
 37.35  recipients referred to the commissioner by a regional treatment 
 37.36  center preadmission evaluation team.  For purposes of this 
 38.1   clause, home care services means all services provided in the 
 38.2   home or community that would be included in the payment to a 
 38.3   regional treatment center; or 
 38.4      (E) up to the amount medical assistance would reimburse for 
 38.5   facility care for recipients referred to the commissioner by a 
 38.6   preadmission screening team established under section 256B.0911 
 38.7   or 256B.092; and 
 38.8      (F) a reasonable amount of time for the provision of 
 38.9   supervision by a qualified professional of personal 
 38.10  care assistant services, if a qualified professional is 
 38.11  requested by the recipient or responsible party.  
 38.12     (ii) The number of direct care hours shall be determined 
 38.13  according to the annual cost report submitted to the department 
 38.14  by nursing facilities.  The average number of direct care hours, 
 38.15  as established by May 1, 1992, shall be calculated and 
 38.16  incorporated into the home care limits on July 1, 1992.  These 
 38.17  limits shall be calculated to the nearest quarter hour. 
 38.18     (iii) The home care rating shall be determined by the 
 38.19  commissioner or the commissioner's designee based on information 
 38.20  submitted to the commissioner by the county public health nurse 
 38.21  on forms specified by the commissioner.  The home care rating 
 38.22  shall be a combination of current assessment tools developed 
 38.23  under sections 256B.0911 and 256B.501 with an addition for 
 38.24  seizure activity that will assess the frequency and severity of 
 38.25  seizure activity and with adjustments, additions, and 
 38.26  clarifications that are necessary to reflect the needs and 
 38.27  conditions of recipients who need home care including children 
 38.28  and adults under 65 years of age.  The commissioner shall 
 38.29  establish these forms and protocols under this section and shall 
 38.30  use an advisory group, including representatives of recipients, 
 38.31  providers, and counties, for consultation in establishing and 
 38.32  revising the forms and protocols. 
 38.33     (iv) A recipient shall qualify as having complex medical 
 38.34  needs if the care required is difficult to perform and because 
 38.35  of recipient's medical condition requires more time than 
 38.36  community-based standards allow or requires more skill than 
 39.1   would ordinarily be required and the recipient needs or has one 
 39.2   or more of the following: 
 39.3      (A) daily tube feedings; 
 39.4      (B) daily parenteral therapy; 
 39.5      (C) wound or decubiti care; 
 39.6      (D) postural drainage, percussion, nebulizer treatments, 
 39.7   suctioning, tracheotomy care, oxygen, mechanical ventilation; 
 39.8      (E) catheterization; 
 39.9      (F) ostomy care; 
 39.10     (G) quadriplegia; or 
 39.11     (H) other comparable medical conditions or treatments the 
 39.12  commissioner determines would otherwise require institutional 
 39.13  care.  
 39.14     (v) A recipient shall qualify as having Level I behavior if 
 39.15  there is reasonable supporting evidence that the recipient 
 39.16  exhibits, or that without supervision, observation, or 
 39.17  redirection would exhibit, one or more of the following 
 39.18  behaviors that cause, or have the potential to cause: 
 39.19     (A) injury to the recipient's own body; 
 39.20     (B) physical injury to other people; or 
 39.21     (C) destruction of property. 
 39.22     (vi) Time authorized for personal care relating to Level I 
 39.23  behavior in subclause (v), items (A) to (C), shall be based on 
 39.24  the predictability, frequency, and amount of intervention 
 39.25  required. 
 39.26     (vii) A recipient shall qualify as having Level II behavior 
 39.27  if the recipient exhibits on a daily basis one or more of the 
 39.28  following behaviors that interfere with the completion of 
 39.29  personal care assistant services under subdivision 4, paragraph 
 39.30  (a): 
 39.31     (A) unusual or repetitive habits; 
 39.32     (B) withdrawn behavior; or 
 39.33     (C) offensive behavior. 
 39.34     (viii) A recipient with a home care rating of Level II 
 39.35  behavior in subclause (vii), items (A) to (C), shall be rated as 
 39.36  comparable to a recipient with complex medical needs under 
 40.1   subclause (iv).  If a recipient has both complex medical needs 
 40.2   and Level II behavior, the home care rating shall be the next 
 40.3   complex category up to the maximum rating under subclause (i), 
 40.4   item (B). 
 40.5      (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
 40.6   nursing services shall be prior authorized by the commissioner 
 40.7   or the commissioner's designee.  Prior authorization for private 
 40.8   duty nursing services shall be based on medical necessity and 
 40.9   cost-effectiveness when compared with alternative care options.  
 40.10  The commissioner may authorize medically necessary private duty 
 40.11  nursing services in quarter-hour units when: 
 40.12     (i) the recipient requires more individual and continuous 
 40.13  care than can be provided during a nurse visit; or 
 40.14     (ii) the cares are outside of the scope of services that 
 40.15  can be provided by a home health aide or personal care assistant.
 40.16     The commissioner may authorize: 
 40.17     (A) up to two times the average amount of direct care hours 
 40.18  provided in nursing facilities statewide for case mix 
 40.19  classification "K" as established by the annual cost report 
 40.20  submitted to the department by nursing facilities in May 1992; 
 40.21     (B) private duty nursing in combination with other home 
 40.22  care services up to the total cost allowed under clause (2); 
 40.23     (C) up to 16 hours per day if the recipient requires more 
 40.24  nursing than the maximum number of direct care hours as 
 40.25  established in item (A) and the recipient meets the hospital 
 40.26  admission criteria established under Minnesota Rules, parts 
 40.27  9505.0500 9505.0501 to 9505.0540.  
 40.28     The commissioner may authorize up to 16 hours per day of 
 40.29  medically necessary private duty nursing services or up to 24 
 40.30  hours per day of medically necessary private duty nursing 
 40.31  services until such time as the commissioner is able to make a 
 40.32  determination of eligibility for recipients who are 
 40.33  cooperatively applying for home care services under the 
 40.34  community alternative care program developed under section 
 40.35  256B.49, or until it is determined by the appropriate regulatory 
 40.36  agency that a health benefit plan is or is not required to pay 
 41.1   for appropriate medically necessary health care services.  
 41.2   Recipients or their representatives must cooperatively assist 
 41.3   the commissioner in obtaining this determination.  Recipients 
 41.4   who are eligible for the community alternative care program may 
 41.5   not receive more hours of nursing under this section than would 
 41.6   otherwise be authorized under section 256B.49.  
 41.7      Beginning July 1, 2001, private duty nursing services shall 
 41.8   be authorized for complex and regular care according to section 
 41.9   256B.0627. 
 41.10     (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
 41.11  ventilator-dependent, the monthly medical assistance 
 41.12  authorization for home care services shall not exceed what the 
 41.13  commissioner would pay for care at the highest cost hospital 
 41.14  designated as a long-term hospital under the Medicare program.  
 41.15  For purposes of this clause, home care services means all 
 41.16  services provided in the home that would be included in the 
 41.17  payment for care at the long-term hospital.  
 41.18  "Ventilator-dependent" means an individual who receives 
 41.19  mechanical ventilation for life support at least six hours per 
 41.20  day and is expected to be or has been dependent for at least 30 
 41.21  consecutive days.  
 41.22     (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
 41.23  or the commissioner's designee shall determine the time period 
 41.24  for which a prior authorization shall be effective.  If the 
 41.25  recipient continues to require home care services beyond the 
 41.26  duration of the prior authorization, the home care provider must 
 41.27  request a new prior authorization.  Under no circumstances, 
 41.28  other than the exceptions in paragraph (b), shall a prior 
 41.29  authorization be valid prior to the date the commissioner 
 41.30  receives the request or for more than 12 months.  A recipient 
 41.31  who appeals a reduction in previously authorized home care 
 41.32  services may continue previously authorized services, other than 
 41.33  temporary services under paragraph (h), pending an appeal under 
 41.34  section 256.045.  The commissioner must provide a detailed 
 41.35  explanation of why the authorized services are reduced in amount 
 41.36  from those requested by the home care provider.  
 42.1      (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
 42.2   the commissioner's designee shall determine the medical 
 42.3   necessity of home care services, the level of caregiver 
 42.4   according to subdivision 2, and the institutional comparison 
 42.5   according to this subdivision, the cost-effectiveness of 
 42.6   services, and the amount, scope, and duration of home care 
 42.7   services reimbursable by medical assistance, based on the 
 42.8   assessment, primary payer coverage determination information as 
 42.9   required, the service plan, the recipient's age, the cost of 
 42.10  services, the recipient's medical condition, and diagnosis or 
 42.11  disability.  The commissioner may publish additional criteria 
 42.12  for determining medical necessity according to section 256B.04. 
 42.13     (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
 42.14  The agency nurse, the independently enrolled private duty nurse, 
 42.15  or county public health nurse may request a temporary 
 42.16  authorization for home care services by telephone.  The 
 42.17  commissioner may approve a temporary level of home care services 
 42.18  based on the assessment, and service or care plan information, 
 42.19  and primary payer coverage determination information as required.
 42.20  Authorization for a temporary level of home care services 
 42.21  including nurse supervision is limited to the time specified by 
 42.22  the commissioner, but shall not exceed 45 days, unless extended 
 42.23  because the county public health nurse has not completed the 
 42.24  required assessment and service plan, or the commissioner's 
 42.25  determination has not been made.  The level of services 
 42.26  authorized under this provision shall have no bearing on a 
 42.27  future prior authorization. 
 42.28     (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
 42.29  Home care services provided in an adult or child foster care 
 42.30  setting must receive prior authorization by the department 
 42.31  according to the limits established in paragraph (a). 
 42.32     The commissioner may not authorize: 
 42.33     (1) home care services that are the responsibility of the 
 42.34  foster care provider under the terms of the foster care 
 42.35  placement agreement and administrative rules; 
 42.36     (2) personal care assistant services when the foster care 
 43.1   license holder is also the personal care provider or personal 
 43.2   care assistant unless the recipient can direct the recipient's 
 43.3   own care, or case management is provided as required in section 
 43.4   256B.0625, subdivision 19a; 
 43.5      (3) personal care assistant services when the responsible 
 43.6   party is an employee of, or under contract with, or has any 
 43.7   direct or indirect financial relationship with the personal care 
 43.8   provider or personal care assistant, unless case management is 
 43.9   provided as required in section 256B.0625, subdivision 19a; or 
 43.10     (4) personal care assistant and private duty nursing 
 43.11  services when the number of foster care residents is greater 
 43.12  than four unless the county responsible for the recipient's 
 43.13  foster placement made the placement prior to April 1, 1992, 
 43.14  requests that personal care assistant and private duty nursing 
 43.15  services be provided, and case management is provided as 
 43.16  required in section 256B.0625, subdivision 19a. 
 43.17     Sec. 30.  Minnesota Statutes 2000, section 256B.0627, 
 43.18  subdivision 7, is amended to read: 
 43.19     Subd. 7.  [NONCOVERED HOME CARE SERVICES.] The following 
 43.20  home care services are not eligible for payment under medical 
 43.21  assistance:  
 43.22     (1) skilled nurse visits for the sole purpose of 
 43.23  supervision of the home health aide; 
 43.24     (2) a skilled nursing visit: 
 43.25     (i) only for the purpose of monitoring medication 
 43.26  compliance with an established medication program for a 
 43.27  recipient; or 
 43.28     (ii) to administer or assist with medication 
 43.29  administration, including injections, prefilling syringes for 
 43.30  injections, or oral medication set-up of an adult recipient, 
 43.31  when as determined and documented by the registered nurse, the 
 43.32  need can be met by an available pharmacy or the recipient is 
 43.33  physically and mentally able to self-administer or prefill a 
 43.34  medication; 
 43.35     (3) home care services to a recipient who is eligible for 
 43.36  covered services including hospice, if elected by the recipient, 
 44.1   under the Medicare program or any other insurance held by the 
 44.2   recipient; 
 44.3      (4) services to other members of the recipient's household; 
 44.4      (5) a visit made by a skilled nurse solely to train other 
 44.5   home health agency workers; 
 44.6      (6) any home care service included in the daily rate of the 
 44.7   community-based residential facility where the recipient is 
 44.8   residing; 
 44.9      (7) nursing and rehabilitation therapy services that are 
 44.10  reasonably accessible to a recipient outside the recipient's 
 44.11  place of residence, excluding the assessment, counseling and 
 44.12  education, and personal assistant care; 
 44.13     (8) any home health agency service, excluding personal care 
 44.14  assistant services and private duty nursing services, which are 
 44.15  performed in a place other than the recipient's residence; and 
 44.16     (9) Medicare evaluation or administrative nursing visits on 
 44.17  dual-eligible recipients that do not qualify for Medicare visit 
 44.18  billing. 
 44.19     Sec. 31.  Minnesota Statutes 2000, section 256B.0627, 
 44.20  subdivision 8, is amended to read: 
 44.21     Subd. 8.  [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 
 44.22  Medical assistance payments for shared personal care assistance 
 44.23  services shall be limited according to this subdivision. 
 44.24     (b) Recipients of personal care assistant services may 
 44.25  share staff and the commissioner shall provide a rate system for 
 44.26  shared personal care assistant services.  For two persons 
 44.27  sharing services, the rate paid to a provider shall not exceed 
 44.28  1-1/2 times the rate paid for serving a single individual, and 
 44.29  for three persons sharing services, the rate paid to a provider 
 44.30  shall not exceed twice the rate paid for serving a single 
 44.31  individual.  These rates apply only to situations in which all 
 44.32  recipients were present and received shared services on the date 
 44.33  for which the service is billed.  No more than three persons may 
 44.34  receive shared services from a personal care assistant in a 
 44.35  single setting. 
 44.36     (c) Shared service is the provision of personal 
 45.1   care assistant services by a personal care assistant to two or 
 45.2   three recipients at the same time and in the same setting.  For 
 45.3   the purposes of this subdivision, "setting" means: 
 45.4      (1) the home or foster care home of one of the individual 
 45.5   recipients; or 
 45.6      (2) a child care program in which all recipients served by 
 45.7   one personal care assistant are participating, which is licensed 
 45.8   under chapter 245A or operated by a local school district or 
 45.9   private school; or 
 45.10     (3) outside the home or foster care home of one of the 
 45.11  recipients when normal life activities take the recipients 
 45.12  outside the home.  
 45.13     The provisions of this subdivision do not apply when a 
 45.14  personal care assistant is caring for multiple recipients in 
 45.15  more than one setting. 
 45.16     (d) The recipient or the recipient's responsible party, in 
 45.17  conjunction with the county public health nurse, shall determine:
 45.18     (1) whether shared personal care assistant services is an 
 45.19  appropriate option based on the individual needs and preferences 
 45.20  of the recipient; and 
 45.21     (2) the amount of shared services allocated as part of the 
 45.22  overall authorization of personal care assistant services. 
 45.23     The recipient or the responsible party, in conjunction with 
 45.24  the supervising qualified professional, if a qualified 
 45.25  professional is requested by any one of the recipients or 
 45.26  responsible parties, shall arrange the setting and grouping of 
 45.27  shared services based on the individual needs and preferences of 
 45.28  the recipients.  Decisions on the selection of recipients to 
 45.29  share services must be based on the ages of the recipients, 
 45.30  compatibility, and coordination of their care needs. 
 45.31     (e) The following items must be considered by the recipient 
 45.32  or the responsible party and the supervising qualified 
 45.33  professional, if a qualified professional has been requested by 
 45.34  any one of the recipients or responsible parties, and documented 
 45.35  in the recipient's health service record: 
 45.36     (1) the additional qualifications needed by the personal 
 46.1   care assistant to provide care to several recipients in the same 
 46.2   setting; 
 46.3      (2) the additional training and supervision needed by the 
 46.4   personal care assistant to ensure that the needs of the 
 46.5   recipient are met appropriately and safely.  The provider must 
 46.6   provide on-site supervision by a qualified professional within 
 46.7   the first 14 days of shared services, and monthly thereafter, if 
 46.8   supervision by a qualified provider has been requested by any 
 46.9   one of the recipients or responsible parties; 
 46.10     (3) the setting in which the shared services will be 
 46.11  provided; 
 46.12     (4) the ongoing monitoring and evaluation of the 
 46.13  effectiveness and appropriateness of the service and process 
 46.14  used to make changes in service or setting; and 
 46.15     (5) a contingency plan which accounts for absence of the 
 46.16  recipient in a shared services setting due to illness or other 
 46.17  circumstances and staffing contingencies. 
 46.18     (f) The provider must offer the recipient or the 
 46.19  responsible party the option of shared or one-on-one personal 
 46.20  care assistant services.  The recipient or the responsible party 
 46.21  can withdraw from participating in a shared services arrangement 
 46.22  at any time. 
 46.23     (g) In addition to documentation requirements under 
 46.24  Minnesota Rules, part 9505.2175, a personal care provider must 
 46.25  meet documentation requirements for shared personal care 
 46.26  assistant services and must document the following in the health 
 46.27  service record for each individual recipient sharing services: 
 46.28     (1) permission by the recipient or the recipient's 
 46.29  responsible party, if any, for the maximum number of shared 
 46.30  services hours per week chosen by the recipient; 
 46.31     (2) permission by the recipient or the recipient's 
 46.32  responsible party, if any, for personal care assistant services 
 46.33  provided outside the recipient's residence; 
 46.34     (3) permission by the recipient or the recipient's 
 46.35  responsible party, if any, for others to receive shared services 
 46.36  in the recipient's residence; 
 47.1      (4) revocation by the recipient or the recipient's 
 47.2   responsible party, if any, of the shared service authorization, 
 47.3   or the shared service to be provided to others in the 
 47.4   recipient's residence, or the shared service to be provided 
 47.5   outside the recipient's residence; 
 47.6      (5) supervision of the shared personal care assistant 
 47.7   services by the qualified professional, if a qualified 
 47.8   professional is requested by one of the recipients or 
 47.9   responsible parties, including the date, time of day, number of 
 47.10  hours spent supervising the provision of shared services, 
 47.11  whether the supervision was face-to-face or another method of 
 47.12  supervision, changes in the recipient's condition, shared 
 47.13  services scheduling issues and recommendations; 
 47.14     (6) documentation by the qualified professional, if a 
 47.15  qualified professional is requested by one of the recipients or 
 47.16  responsible parties, of telephone calls or other discussions 
 47.17  with the personal care assistant regarding services being 
 47.18  provided to the recipient who has requested the supervision; and 
 47.19     (7) daily documentation of the shared services provided by 
 47.20  each identified personal care assistant including: 
 47.21     (i) the names of each recipient receiving shared services 
 47.22  together; 
 47.23     (ii) the setting for the shared services, including the 
 47.24  starting and ending times that the recipient received shared 
 47.25  services; and 
 47.26     (iii) notes by the personal care assistant regarding 
 47.27  changes in the recipient's condition, problems that may arise 
 47.28  from the sharing of services, scheduling issues, care issues, 
 47.29  and other notes as required by the qualified professional, if a 
 47.30  qualified professional is requested by one of the recipients or 
 47.31  responsible parties. 
 47.32     (h) Unless otherwise provided in this subdivision, all 
 47.33  other statutory and regulatory provisions relating to personal 
 47.34  care assistant services apply to shared services. 
 47.35     (i) In the event that supervision by a qualified 
 47.36  professional has been requested by one or more recipients, but 
 48.1   not by all of the recipients, the supervision duties of the 
 48.2   qualified professional shall be limited to only those recipients 
 48.3   who have requested the supervision. 
 48.4      Nothing in this subdivision shall be construed to reduce 
 48.5   the total number of hours authorized for an individual recipient.
 48.6      Sec. 32.  Minnesota Statutes 2000, section 256B.0627, 
 48.7   subdivision 10, is amended to read: 
 48.8      Subd. 10.  [FISCAL AGENT INTERMEDIARY OPTION AVAILABLE FOR 
 48.9   PERSONAL CARE ASSISTANT SERVICES.] (a) "Fiscal agent option" is 
 48.10  an option that allows the recipient to: 
 48.11     (1) use a fiscal agent instead of a personal care provider 
 48.12  organization; 
 48.13     (2) supervise the personal care assistant; and 
 48.14     (3) use a consulting professional. 
 48.15     The commissioner may allow a recipient of personal care 
 48.16  assistant services to use a fiscal agent intermediary to assist 
 48.17  the recipient in paying and accounting for medically necessary 
 48.18  covered personal care assistant services authorized in 
 48.19  subdivision 4 and within the payment parameters of subdivision 
 48.20  5.  Unless otherwise provided in this subdivision, all other 
 48.21  statutory and regulatory provisions relating to personal care 
 48.22  assistant services apply to a recipient using the fiscal agent 
 48.23  intermediary option. 
 48.24     (b) The recipient or responsible party shall: 
 48.25     (1) hire, and terminate the personal care assistant and 
 48.26  consulting professional, with the fiscal agent recruit, hire, 
 48.27  and terminate a qualified professional, if a qualified 
 48.28  professional is requested by the recipient or responsible party; 
 48.29     (2) recruit the personal care assistant and consulting 
 48.30  professional and orient and train the personal care assistant in 
 48.31  areas that do not require professional delegation as determined 
 48.32  by the county public health nurse verify and document the 
 48.33  credentials of the qualified professional, if a qualified 
 48.34  professional is requested by the recipient or responsible party; 
 48.35     (3) supervise and evaluate the personal care assistant in 
 48.36  areas that do not require professional delegation as determined 
 49.1   in the assessment; 
 49.2      (4) cooperate with a consulting develop a service plan 
 49.3   based on physician orders and public health nurse assessment 
 49.4   with the assistance of a qualified professional and implement 
 49.5   recommendations pertaining to the health and safety of the 
 49.6   recipient, if a qualified professional is requested by the 
 49.7   recipient or responsible party, that addresses the health and 
 49.8   safety of the recipient; 
 49.9      (5) hire a qualified professional to train and supervise 
 49.10  the performance of delegated tasks done by (4) recruit, hire, 
 49.11  and terminate the personal care assistant; 
 49.12     (6) monitor services and verify in writing the hours worked 
 49.13  by the personal care assistant and the consulting (5) orient and 
 49.14  train the personal care assistant with assistance as needed from 
 49.15  the qualified professional; 
 49.16     (7) develop and revise a care plan with assistance from a 
 49.17  consulting (6) supervise and evaluate the personal care 
 49.18  assistant with assistance as needed from the recipient's 
 49.19  physician or the qualified professional; 
 49.20     (8) verify and document the credentials of the consulting 
 49.21  (7) monitor and verify in writing and report to the fiscal 
 49.22  intermediary the number of hours worked by the personal care 
 49.23  assistant and the qualified professional; and 
 49.24     (9) (8) enter into a written agreement, as specified in 
 49.25  paragraph (f). 
 49.26     (c) The duties of the fiscal agent intermediary shall be to:
 49.27     (1) bill the medical assistance program for personal care 
 49.28  assistant and consulting qualified professional services; 
 49.29     (2) request and secure background checks on personal care 
 49.30  assistants and consulting qualified professionals according to 
 49.31  section 245A.04; 
 49.32     (3) pay the personal care assistant and consulting 
 49.33  qualified professional based on actual hours of services 
 49.34  provided; 
 49.35     (4) withhold and pay all applicable federal and state 
 49.36  taxes; 
 50.1      (5) verify and document keep records hours worked by the 
 50.2   personal care assistant and consulting qualified professional; 
 50.3      (6) make the arrangements and pay unemployment insurance, 
 50.4   taxes, workers' compensation, liability insurance, and other 
 50.5   benefits, if any; 
 50.6      (7) enroll in the medical assistance program as a fiscal 
 50.7   agent intermediary; and 
 50.8      (8) enter into a written agreement as specified in 
 50.9   paragraph (f) before services are provided. 
 50.10     (d) The fiscal agent intermediary: 
 50.11     (1) may not be related to the recipient, consulting 
 50.12  qualified professional, or the personal care assistant; 
 50.13     (2) must ensure arm's length transactions with the 
 50.14  recipient and personal care assistant; and 
 50.15     (3) shall be considered a joint employer of the personal 
 50.16  care assistant and consulting qualified professional to the 
 50.17  extent specified in this section. 
 50.18     The fiscal agent intermediary or owners of the entity that 
 50.19  provides fiscal agent intermediary services under this 
 50.20  subdivision must pass a criminal background check as required in 
 50.21  section 256B.0627, subdivision 1, paragraph (e). 
 50.22     (e) If the recipient or responsible party requests a 
 50.23  qualified professional, the consulting qualified professional 
 50.24  providing assistance to the recipient shall meet the 
 50.25  qualifications specified in section 256B.0625, subdivision 19c.  
 50.26  The consulting qualified professional shall assist the recipient 
 50.27  in developing and revising a plan to meet the 
 50.28  recipient's assessed needs, and supervise the performance of 
 50.29  delegated tasks, as determined by the public health nurse as 
 50.30  assessed by the public health nurse.  In performing this 
 50.31  function, the consulting qualified professional must visit the 
 50.32  recipient in the recipient's home at least once annually.  
 50.33  The consulting qualified professional must report to the local 
 50.34  county public health nurse concerns relating to the health and 
 50.35  safety of the recipient, and any suspected abuse, neglect, or 
 50.36  financial exploitation of the recipient to the appropriate 
 51.1   authorities.  
 51.2      (f) The fiscal agent intermediary, recipient or responsible 
 51.3   party, personal care assistant, and consulting qualified 
 51.4   professional shall enter into a written agreement before 
 51.5   services are started.  The agreement shall include: 
 51.6      (1) the duties of the recipient, qualified professional, 
 51.7   personal care assistant, and fiscal agent based on paragraphs 
 51.8   (a) to (e); 
 51.9      (2) the salary and benefits for the personal care assistant 
 51.10  and those providing professional consultation the qualified 
 51.11  professional; 
 51.12     (3) the administrative fee of the fiscal agent intermediary 
 51.13  and services paid for with that fee, including background check 
 51.14  fees; 
 51.15     (4) procedures to respond to billing or payment complaints; 
 51.16  and 
 51.17     (5) procedures for hiring and terminating the personal care 
 51.18  assistant and those providing professional consultation the 
 51.19  qualified professional. 
 51.20     (g) The rates paid for personal care assistant services, 
 51.21  qualified professional assistance services, and fiscal agency 
 51.22  intermediary services under this subdivision shall be the same 
 51.23  rates paid for personal care assistant services and qualified 
 51.24  professional services under subdivision 2 respectively.  Except 
 51.25  for the administrative fee of the fiscal agent intermediary 
 51.26  specified in paragraph (f), the remainder of the rates paid to 
 51.27  the fiscal agent intermediary must be used to pay for the salary 
 51.28  and benefits for the personal care assistant or those providing 
 51.29  professional consultation the qualified professional. 
 51.30     (h) As part of the assessment defined in subdivision 1, the 
 51.31  following conditions must be met to use or continue use of a 
 51.32  fiscal agent intermediary: 
 51.33     (1) the recipient must be able to direct the recipient's 
 51.34  own care, or the responsible party for the recipient must be 
 51.35  readily available to direct the care of the personal care 
 51.36  assistant; 
 52.1      (2) the recipient or responsible party must be 
 52.2   knowledgeable of the health care needs of the recipient and be 
 52.3   able to effectively communicate those needs; 
 52.4      (3) a face-to-face assessment must be conducted by the 
 52.5   local county public health nurse at least annually, or when 
 52.6   there is a significant change in the recipient's condition or 
 52.7   change in the need for personal care assistant services.  The 
 52.8   county public health nurse shall determine the services that 
 52.9   require professional delegation, if any, and the amount and 
 52.10  frequency of related supervision; 
 52.11     (4) the recipient cannot select the shared services option 
 52.12  as specified in subdivision 8; and 
 52.13     (5) parties must be in compliance with the written 
 52.14  agreement specified in paragraph (f). 
 52.15     (i) The commissioner shall deny, revoke, or suspend the 
 52.16  authorization to use the fiscal agent intermediary option if: 
 52.17     (1) it has been determined by the consulting qualified 
 52.18  professional or local county public health nurse that the use of 
 52.19  this option jeopardizes the recipient's health and safety; 
 52.20     (2) the parties have failed to comply with the written 
 52.21  agreement specified in paragraph (f); or 
 52.22     (3) the use of the option has led to abusive or fraudulent 
 52.23  billing for personal care assistant services.  
 52.24     The recipient or responsible party may appeal the 
 52.25  commissioner's action according to section 256.045.  The denial, 
 52.26  revocation, or suspension to use the fiscal agent intermediary 
 52.27  option shall not affect the recipient's authorized level of 
 52.28  personal care assistant services as determined in subdivision 5. 
 52.29     Sec. 33.  Minnesota Statutes 2000, section 256B.0627, 
 52.30  subdivision 11, is amended to read: 
 52.31     Subd. 11.  [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 
 52.32  Medical assistance payments for shared private duty nursing 
 52.33  services by a private duty nurse shall be limited according to 
 52.34  this subdivision.  For the purposes of this section, "private 
 52.35  duty nursing agency" means an agency licensed under chapter 144A 
 52.36  to provide private duty nursing services. 
 53.1      (b) Recipients of private duty nursing services may share 
 53.2   nursing staff and the commissioner shall provide a rate 
 53.3   methodology for shared private duty nursing.  For two persons 
 53.4   sharing nursing care, the rate paid to a provider shall not 
 53.5   exceed 1.5 times the nonwaivered regular private duty nursing 
 53.6   rates paid for serving a single individual who is not ventilator 
 53.7   dependent, by a registered nurse or licensed practical nurse.  
 53.8   These rates apply only to situations in which both recipients 
 53.9   are present and receive shared private duty nursing care on the 
 53.10  date for which the service is billed.  No more than two persons 
 53.11  may receive shared private duty nursing services from a private 
 53.12  duty nurse in a single setting. 
 53.13     (c) Shared private duty nursing care is the provision of 
 53.14  nursing services by a private duty nurse to two recipients at 
 53.15  the same time and in the same setting.  For the purposes of this 
 53.16  subdivision, "setting" means: 
 53.17     (1) the home or foster care home of one of the individual 
 53.18  recipients; or 
 53.19     (2) a child care program licensed under chapter 245A or 
 53.20  operated by a local school district or private school; or 
 53.21     (3) an adult day care service licensed under chapter 245A; 
 53.22  or 
 53.23     (4) outside the home or foster care home of one of the 
 53.24  recipients when normal life activities take the recipients 
 53.25  outside the home.  
 53.26     This subdivision does not apply when a private duty nurse 
 53.27  is caring for multiple recipients in more than one setting. 
 53.28     (d) The recipient or the recipient's legal representative, 
 53.29  and the recipient's physician, in conjunction with the home 
 53.30  health care agency, shall determine: 
 53.31     (1) whether shared private duty nursing care is an 
 53.32  appropriate option based on the individual needs and preferences 
 53.33  of the recipient; and 
 53.34     (2) the amount of shared private duty nursing services 
 53.35  authorized as part of the overall authorization of nursing 
 53.36  services. 
 54.1      (e) The recipient or the recipient's legal representative, 
 54.2   in conjunction with the private duty nursing agency, shall 
 54.3   approve the setting, grouping, and arrangement of shared private 
 54.4   duty nursing care based on the individual needs and preferences 
 54.5   of the recipients.  Decisions on the selection of recipients to 
 54.6   share services must be based on the ages of the recipients, 
 54.7   compatibility, and coordination of their care needs. 
 54.8      (f) The following items must be considered by the recipient 
 54.9   or the recipient's legal representative and the private duty 
 54.10  nursing agency, and documented in the recipient's health service 
 54.11  record: 
 54.12     (1) the additional training needed by the private duty 
 54.13  nurse to provide care to two recipients in the same setting and 
 54.14  to ensure that the needs of the recipients are met appropriately 
 54.15  and safely; 
 54.16     (2) the setting in which the shared private duty nursing 
 54.17  care will be provided; 
 54.18     (3) the ongoing monitoring and evaluation of the 
 54.19  effectiveness and appropriateness of the service and process 
 54.20  used to make changes in service or setting; 
 54.21     (4) a contingency plan which accounts for absence of the 
 54.22  recipient in a shared private duty nursing setting due to 
 54.23  illness or other circumstances; 
 54.24     (5) staffing backup contingencies in the event of employee 
 54.25  illness or absence; and 
 54.26     (6) arrangements for additional assistance to respond to 
 54.27  urgent or emergency care needs of the recipients. 
 54.28     (g) The provider must offer the recipient or responsible 
 54.29  party the option of shared or one-on-one private duty nursing 
 54.30  services.  The recipient or responsible party can withdraw from 
 54.31  participating in a shared service arrangement at any time. 
 54.32     (h) The private duty nursing agency must document the 
 54.33  following in the health service record for each individual 
 54.34  recipient sharing private duty nursing care: 
 54.35     (1) permission by the recipient or the recipient's legal 
 54.36  representative for the maximum number of shared nursing care 
 55.1   hours per week chosen by the recipient; 
 55.2      (2) permission by the recipient or the recipient's legal 
 55.3   representative for shared private duty nursing services provided 
 55.4   outside the recipient's residence; 
 55.5      (3) permission by the recipient or the recipient's legal 
 55.6   representative for others to receive shared private duty nursing 
 55.7   services in the recipient's residence; 
 55.8      (4) revocation by the recipient or the recipient's legal 
 55.9   representative of the shared private duty nursing care 
 55.10  authorization, or the shared care to be provided to others in 
 55.11  the recipient's residence, or the shared private duty nursing 
 55.12  services to be provided outside the recipient's residence; and 
 55.13     (5) daily documentation of the shared private duty nursing 
 55.14  services provided by each identified private duty nurse, 
 55.15  including: 
 55.16     (i) the names of each recipient receiving shared private 
 55.17  duty nursing services together; 
 55.18     (ii) the setting for the shared services, including the 
 55.19  starting and ending times that the recipient received shared 
 55.20  private duty nursing care; and 
 55.21     (iii) notes by the private duty nurse regarding changes in 
 55.22  the recipient's condition, problems that may arise from the 
 55.23  sharing of private duty nursing services, and scheduling and 
 55.24  care issues. 
 55.25     (i) Unless otherwise provided in this subdivision, all 
 55.26  other statutory and regulatory provisions relating to private 
 55.27  duty nursing services apply to shared private duty nursing 
 55.28  services. 
 55.29     Nothing in this subdivision shall be construed to reduce 
 55.30  the total number of private duty nursing hours authorized for an 
 55.31  individual recipient under subdivision 5. 
 55.32     Sec. 34.  Minnesota Statutes 2000, section 256B.0627, is 
 55.33  amended by adding a subdivision to read: 
 55.34     Subd. 13.  [CONSUMER-DIRECTED HOME CARE DEMONSTRATION 
 55.35  PROJECT.] (a) Upon the receipt of federal waiver authority, the 
 55.36  commissioner shall implement a consumer-directed home care 
 56.1   demonstration project.  The consumer-directed home care 
 56.2   demonstration project must demonstrate and evaluate the outcomes 
 56.3   of a consumer-directed service delivery alternative to improve 
 56.4   access, increase consumer control and accountability over 
 56.5   available resources, and enable the use of supports that are 
 56.6   more individualized and cost-effective for eligible medical 
 56.7   assistance recipients receiving certain medical assistance home 
 56.8   care services.  The consumer-directed home care demonstration 
 56.9   project will be administered locally by county agencies, tribal 
 56.10  governments, or administrative entities under contract with the 
 56.11  state in regions where counties choose not to provide this 
 56.12  service. 
 56.13     (b) Grant awards for persons who have been receiving 
 56.14  medical assistance covered personal care, home health aide, or 
 56.15  private duty nursing services for a period of 12 consecutive 
 56.16  months or more prior to enrollment in the consumer-directed home 
 56.17  care demonstration project will be established on a case-by-case 
 56.18  basis using historical service expenditure data.  An average 
 56.19  monthly expenditure for each continuing enrollee will be 
 56.20  calculated based on historical expenditures made on behalf of 
 56.21  the enrollee for personal care, home health aide, or private 
 56.22  duty nursing services during the 12 month period directly prior 
 56.23  to enrollment in the project.  The grant award will equal 90 
 56.24  percent of the average monthly expenditure. 
 56.25     (c) Grant awards for project enrollees who have been 
 56.26  receiving medical assistance covered personal care, home health 
 56.27  aide, or private duty nursing services for a period of less than 
 56.28  12 consecutive months prior to project enrollment will be 
 56.29  calculated on a case-by-case basis using the service 
 56.30  authorization in place at the time of enrollment.  The total 
 56.31  number of units of personal care, home health aide, or private 
 56.32  duty nursing services the enrollee has been authorized to 
 56.33  receive will be converted to the total cost of the authorized 
 56.34  services in a given month using the statewide average service 
 56.35  payment rates.  To determine an estimated monthly expenditure, 
 56.36  the total authorized monthly personal care, home health aide or 
 57.1   private duty nursing service costs will be reduced by a 
 57.2   percentage rate equivalent to the difference between the 
 57.3   statewide average service authorization and the statewide 
 57.4   average utilization rate for each of the services by medical 
 57.5   assistance eligibles during the most recent fiscal year for 
 57.6   which 12 months of data is available.  The grant award will 
 57.7   equal 90 percent of the estimated monthly expenditure. 
 57.8      Sec. 35.  Minnesota Statutes 2000, section 256B.0627, is 
 57.9   amended by adding a subdivision to read: 
 57.10     Subd. 14.  [TELEHOMECARE; SKILLED NURSE VISITS.] Medical 
 57.11  assistance covers skilled nurse visits according to section 
 57.12  256B.0625, subdivision 6a, provided via telehomecare, for 
 57.13  services which do not require hands-on care between the home 
 57.14  care nurse and recipient.  The provision of telehomecare must be 
 57.15  made via live, two-way interactive audiovisual technology and 
 57.16  may be augmented by utilizing store-and-forward technologies.  
 57.17  Store-and-forward technology includes telehomecare services that 
 57.18  do not occur in real time via synchronous transmissions, and 
 57.19  that do not require a face-to-face encounter with the recipient 
 57.20  for all or any part of any such telehomecare visit.  A 
 57.21  communication between the home care nurse and recipient that 
 57.22  consists solely of a telephone conversation, facsimile, 
 57.23  electronic mail, or a consultation between two health care 
 57.24  practitioners, is not to be considered a telehomecare visit.  
 57.25  Multiple daily skilled nurse visits provided via telehomecare 
 57.26  are allowed.  Coverage of telehomecare is limited to two visits 
 57.27  per day.  All skilled nurse visits provided via telehomecare 
 57.28  must be prior authorized by the commissioner or the 
 57.29  commissioner's designee and will be covered at the same 
 57.30  allowable rate as skilled nurse visits provided in-person. 
 57.31     Sec. 36.  Minnesota Statutes 2000, section 256B.0627, is 
 57.32  amended by adding a subdivision to read: 
 57.33     Subd. 15.  [THERAPIES THROUGH HOME HEALTH AGENCIES.] (a)  
 57.34  [PHYSICAL THERAPY.] Medical assistance covers physical therapy 
 57.35  and related services, including specialized maintenance 
 57.36  therapy.  Services provided by a physical therapy assistant 
 58.1   shall be reimbursed at the same rate as services performed by a 
 58.2   physical therapist when the services of the physical therapy 
 58.3   assistant are provided under the direction of a physical 
 58.4   therapist who is on the premises.  Services provided by a 
 58.5   physical therapy assistant that are provided under the direction 
 58.6   of a physical therapist who is not on the premises shall be 
 58.7   reimbursed at 65 percent of the physical therapist rate.  
 58.8   Direction of the physical therapy assistant must be provided by 
 58.9   the physical therapist as described in Minnesota Rules, part 
 58.10  9505.0390, subpart 1, item B.  The physical therapist and 
 58.11  physical therapist assistant may not both bill for services 
 58.12  provided to a recipient on the same day. 
 58.13     (b)  [OCCUPATIONAL THERAPY.] Medical assistance covers 
 58.14  occupational therapy and related services, including specialized 
 58.15  maintenance therapy.  Services provided by an occupational 
 58.16  therapy assistant shall be reimbursed at the same rate as 
 58.17  services performed by an occupational therapist when the 
 58.18  services of the occupational therapy assistant are provided 
 58.19  under the direction of the occupational therapist who is on the 
 58.20  premises.  Services provided by an occupational therapy 
 58.21  assistant under the direction of an occupational therapist who 
 58.22  is not on the premises shall be reimbursed at 65 percent of the 
 58.23  occupational therapist rate.  Direction of the occupational 
 58.24  therapy assistant must be provided by the occupational therapist 
 58.25  as described in Minnesota Rules, part 9505.0390, subpart 1, item 
 58.26  B.  The occupational therapist and occupational therapist 
 58.27  assistant may not both bill for services provided to a recipient 
 58.28  on the same day. 
 58.29     Sec. 37.  Minnesota Statutes 2000, section 256B.0627, is 
 58.30  amended by adding a subdivision to read: 
 58.31     Subd. 16.  [HARDSHIP CRITERIA; PRIVATE DUTY NURSING.] (a) 
 58.32  Payment is allowed for extraordinary services that require 
 58.33  specialized nursing skills and are provided by parents of minor 
 58.34  children, spouses, and legal guardians who are providing private 
 58.35  duty nursing care under the following conditions: 
 58.36     (1) the provision of these services is not legally required 
 59.1   of the parents, spouses, or legal guardians; 
 59.2      (2) the services are necessary to prevent hospitalization 
 59.3   of the recipient; and 
 59.4      (3) the recipient is eligible for state plan home care or a 
 59.5   home and community-based waiver and one of the following 
 59.6   hardship criteria are met: 
 59.7      (i) the parent, spouse, or legal guardian resigns from a 
 59.8   part-time or full-time job to provide nursing care for the 
 59.9   recipient; or 
 59.10     (ii) the parent, spouse, or legal guardian goes from a 
 59.11  full-time to a part-time job with less compensation to provide 
 59.12  nursing care for the recipient; or 
 59.13     (iii) the parent, spouse, or legal guardian takes a leave 
 59.14  of absence without pay to provide nursing care for the 
 59.15  recipient; or 
 59.16     (iv) because of labor conditions, special language needs, 
 59.17  or intermittent hours of care needed, the parent, spouse, or 
 59.18  legal guardian is needed in order to provide adequate private 
 59.19  duty nursing services to meet the medical needs of the recipient.
 59.20     (b) Private duty nursing may be provided by a parent, 
 59.21  spouse, or legal guardian who is a nurse licensed in Minnesota.  
 59.22  Private duty nursing services provided by a parent, spouse, or 
 59.23  legal guardian cannot be used in lieu of nursing services 
 59.24  covered and available under liable third-party payors, including 
 59.25  Medicare.  The private duty nursing provided by a parent, 
 59.26  spouse, or legal guardian must be included in the service plan.  
 59.27  Authorized skilled nursing services provided by the parent, 
 59.28  spouse, or legal guardian may not exceed 50 percent of the total 
 59.29  approved nursing hours, or eight hours per day, whichever is 
 59.30  less, up to a maximum of 40 hours per week.  Nothing in this 
 59.31  subdivision precludes the parent's, spouse's, or legal 
 59.32  guardian's obligation of assuming the nonreimbursed family 
 59.33  responsibilities of emergency backup caregiver and primary 
 59.34  caregiver. 
 59.35     (c) A parent or a spouse may not be paid to provide private 
 59.36  duty nursing care if the parent or spouse fails to pass a 
 60.1   criminal background check according to section 245A.04, or if it 
 60.2   has been determined by the home health agency, the case manager, 
 60.3   or the physician that the private duty nursing care provided by 
 60.4   the parent, spouse, or legal guardian is unsafe. 
 60.5      Sec. 38.  Minnesota Statutes 2000, section 256B.0627, is 
 60.6   amended by adding a subdivision to read: 
 60.7      Subd. 17.  [QUALITY ASSURANCE PLAN FOR PERSONAL CARE 
 60.8   ASSISTANT SERVICES.] The commissioner shall establish a quality 
 60.9   assurance plan for personal care assistant services that 
 60.10  includes: 
 60.11     (1) performance-based provider agreements; 
 60.12     (2) meaningful consumer input, which may include consumer 
 60.13  surveys, that measure the extent to which participants receive 
 60.14  the services and supports described in the individual plan and 
 60.15  participant satisfaction with such services and supports; 
 60.16     (3) ongoing monitoring of the health and well-being of 
 60.17  consumers; and 
 60.18     (4) an ongoing public process for development, 
 60.19  implementation, and review of the quality assurance plan.  
 60.20     Sec. 39.  Minnesota Statutes 2000, section 256B.0911, is 
 60.21  amended by adding a subdivision to read: 
 60.22     Subd. 4a.  [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 
 60.23  YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 
 60.24  ensure that individuals with disabilities or chronic illness are 
 60.25  served in the most integrated setting appropriate to their needs 
 60.26  and have the necessary information to make informed choices 
 60.27  about home and community-based service options. 
 60.28     (b) Individuals under 65 years of age who are admitted to a 
 60.29  nursing facility from a hospital must be screened prior to 
 60.30  admission as outlined in subdivision 4. 
 60.31     (c) Individuals under 65 years of age who are admitted to 
 60.32  nursing facilities with only a telephone screening must receive 
 60.33  a face-to-face assessment from the long-term care consultation 
 60.34  team member of the county in which the facility is located or 
 60.35  from the recipient's county case manager within 20 working days 
 60.36  of admission. 
 61.1      (d) At the face-to-face assessment, the long-term care 
 61.2   consultation team member or county case manager must perform the 
 61.3   activities required under subdivision 3. 
 61.4      (e) For individuals under 21 years of age, the screening or 
 61.5   assessment which recommends nursing facility admission must be 
 61.6   approved by the commissioner before the individual is admitted 
 61.7   to the nursing facility. 
 61.8      (f) In the event that an individual under 65 years of age 
 61.9   is admitted to a nursing facility on an emergency basis, the 
 61.10  county must be notified of the admission on the next working 
 61.11  day, and a face-to-face assessment as described in paragraph (c) 
 61.12  must be conducted within 20 working days of admission. 
 61.13     (g) At the face-to-face assessment, the long-term care 
 61.14  consultation team member or the case manager must present 
 61.15  information about home and community-based options so the 
 61.16  individual can make informed choices.  If the individual chooses 
 61.17  home and community-based services, the long-term care 
 61.18  consultation team member or case manager must complete a written 
 61.19  relocation plan within 20 working days of the visit.  The plan 
 61.20  shall describe the services needed to move out of the facility 
 61.21  and a timeline for the move which is designed to ensure a smooth 
 61.22  transition to the individual's home and community. 
 61.23     (h) An individual under 65 years of age residing in a 
 61.24  nursing facility shall receive a face-to-face assessment at 
 61.25  least every 12 months to review the person's service choices and 
 61.26  available alternatives unless the individual indicates, in 
 61.27  writing, that annual visits are not desired.  In this case, the 
 61.28  individual must receive a face-to-face assessment at least once 
 61.29  every 36 months for the same purposes. 
 61.30     (i) Notwithstanding the provisions of subdivision 6, the 
 61.31  commissioner may pay county agencies directly for face-to-face 
 61.32  assessments for individuals who are eligible for medical 
 61.33  assistance, under 65 years of age, and being considered for 
 61.34  placement or residing in a nursing facility. 
 61.35     Sec. 40.  Minnesota Statutes 2000, section 256B.093, 
 61.36  subdivision 3, is amended to read: 
 62.1      Subd. 3.  [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 
 62.2   department shall fund administrative case management under this 
 62.3   subdivision using medical assistance administrative funds.  The 
 62.4   traumatic brain injury program duties include: 
 62.5      (1) recommending to the commissioner in consultation with 
 62.6   the medical review agent according to Minnesota Rules, parts 
 62.7   9505.0500 to 9505.0540, the approval or denial of medical 
 62.8   assistance funds to pay for out-of-state placements for 
 62.9   traumatic brain injury services and in-state traumatic brain 
 62.10  injury services provided by designated Medicare long-term care 
 62.11  hospitals; 
 62.12     (2) coordinating the traumatic brain injury home and 
 62.13  community-based waiver; 
 62.14     (3) approving traumatic brain injury waiver eligibility or 
 62.15  care plans or both; 
 62.16     (4) providing ongoing technical assistance and consultation 
 62.17  to county and facility case managers to facilitate care plan 
 62.18  development for appropriate, accessible, and cost-effective 
 62.19  medical assistance services; 
 62.20     (5) (4) providing technical assistance to promote statewide 
 62.21  development of appropriate, accessible, and cost-effective 
 62.22  medical assistance services and related policy; 
 62.23     (6) (5) providing training and outreach to facilitate 
 62.24  access to appropriate home and community-based services to 
 62.25  prevent institutionalization; 
 62.26     (7) (6) facilitating appropriate admissions, continued stay 
 62.27  review, discharges, and utilization review for neurobehavioral 
 62.28  hospitals and other specialized institutions; 
 62.29     (8) (7) providing technical assistance on the use of prior 
 62.30  authorization of home care services and coordination of these 
 62.31  services with other medical assistance services; 
 62.32     (9) (8) developing a system for identification of nursing 
 62.33  facility and hospital residents with traumatic brain injury to 
 62.34  assist in long-term planning for medical assistance services.  
 62.35  Factors will include, but are not limited to, number of 
 62.36  individuals served, length of stay, services received, and 
 63.1   barriers to community placement; and 
 63.2      (10) (9) providing information, referral, and case 
 63.3   consultation to access medical assistance services for 
 63.4   recipients without a county or facility case manager.  Direct 
 63.5   access to this assistance may be limited due to the structure of 
 63.6   the program. 
 63.7      Sec. 41.  Minnesota Statutes 2000, section 256B.095, is 
 63.8   amended to read: 
 63.9      256B.095 [THREE-YEAR QUALITY ASSURANCE PILOT PROJECT 
 63.10  ESTABLISHED.] 
 63.11     Effective July 1, 1998, an alternative quality assurance 
 63.12  licensing system pilot project for programs for persons with 
 63.13  developmental disabilities is established in Dodge, Fillmore, 
 63.14  Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, 
 63.15  Wabasha, and Winona counties for the purpose of improving the 
 63.16  quality of services provided to persons with developmental 
 63.17  disabilities.  A county, at its option, may choose to have all 
 63.18  programs for persons with developmental disabilities located 
 63.19  within the county licensed under chapter 245A using standards 
 63.20  determined under the alternative quality assurance licensing 
 63.21  system pilot project or may continue regulation of these 
 63.22  programs under the licensing system operated by the 
 63.23  commissioner.  The pilot project expires on June 30, 2001 2003. 
 63.24     Sec. 42.  Minnesota Statutes 2000, section 256B.0951, 
 63.25  subdivision 1, is amended to read: 
 63.26     Subdivision 1.  [MEMBERSHIP.] The region 10 quality 
 63.27  assurance commission is established.  The commission consists of 
 63.28  at least 14 but not more than 21 members as follows:  at least 
 63.29  three but not more than five members representing advocacy 
 63.30  organizations; at least three but not more than five members 
 63.31  representing consumers, families, and their legal 
 63.32  representatives; at least three but not more than five members 
 63.33  representing service providers; at least three but not more than 
 63.34  five members representing counties; and the commissioner of 
 63.35  human services or the commissioner's designee.  Initial 
 63.36  membership of the commission shall be recruited and approved by 
 64.1   the region 10 stakeholders group.  Prior to approving the 
 64.2   commission's membership, the stakeholders group shall provide to 
 64.3   the commissioner a list of the membership in the stakeholders 
 64.4   group, as of February 1, 1997, a brief summary of meetings held 
 64.5   by the group since July 1, 1996, and copies of any materials 
 64.6   prepared by the group for public distribution.  The first 
 64.7   commission shall establish membership guidelines for the 
 64.8   transition and recruitment of membership for the commission's 
 64.9   ongoing existence.  Members of the commission who do not receive 
 64.10  a salary or wages from an employer for time spent on commission 
 64.11  duties may receive a per diem payment when performing commission 
 64.12  duties and functions.  All members may be reimbursed for 
 64.13  expenses related to commission activities.  Notwithstanding the 
 64.14  provisions of section 15.059, subdivision 5, the commission 
 64.15  expires on June 30, 2001 2003. 
 64.16     Sec. 43.  Minnesota Statutes 2000, section 256B.0951, 
 64.17  subdivision 3, is amended to read: 
 64.18     Subd. 3.  [COMMISSION DUTIES.] (a) By October 1, 1997, the 
 64.19  commission, in cooperation with the commissioners of human 
 64.20  services and health, shall do the following:  (1) approve an 
 64.21  alternative quality assurance licensing system based on the 
 64.22  evaluation of outcomes; (2) approve measurable outcomes in the 
 64.23  areas of health and safety, consumer evaluation, education and 
 64.24  training, providers, and systems that shall be evaluated during 
 64.25  the alternative licensing process; and (3) establish variable 
 64.26  licensure periods not to exceed three years based on outcomes 
 64.27  achieved.  For purposes of this subdivision, "outcome" means the 
 64.28  behavior, action, or status of a person that can be observed or 
 64.29  measured and can be reliably and validly determined. 
 64.30     (b) By January 15, 1998, the commission shall approve, in 
 64.31  cooperation with the commissioner of human services, a training 
 64.32  program for members of the quality assurance teams established 
 64.33  under section 256B.0952, subdivision 4. 
 64.34     (c) The commission and the commissioner shall establish an 
 64.35  ongoing review process for the alternative quality assurance 
 64.36  licensing system.  The review shall take into account the 
 65.1   comprehensive nature of the alternative system, which is 
 65.2   designed to evaluate the broad spectrum of licensed and 
 65.4   unlicensed entities that provide services to clients, as 
 65.5   compared to the current licensing system.  
 65.6      (d) The commission shall contract with an independent 
 65.7   entity to conduct a financial review of the alternative quality 
 65.8   assurance pilot project.  The review shall take into account the 
 65.9   comprehensive nature of the alternative system, which is 
 65.10  designed to evaluate the broad spectrum of licensed and 
 65.11  unlicensed entities that provide services to clients, as 
 65.12  compared to the current licensing system.  The review shall 
 65.13  include an evaluation of possible budgetary savings within the 
 65.14  department of human services as a result of implementation of 
 65.15  the alternative quality assurance pilot project.  If a federal 
 65.16  waiver is approved under subdivision 7, the financial review 
 65.17  shall also evaluate possible savings within the department of 
 65.18  health.  This review must be completed by December 15, 2000. 
 65.19     (e) The commission shall submit a report to the legislature 
 65.20  by January 15, 2001, on the results of the review process for 
 65.21  the alternative quality assurance pilot project, a summary of 
 65.22  the results of the independent financial review, and a 
 65.23  recommendation on whether the pilot project should be extended 
 65.24  beyond June 30, 2001.  Based upon these recommendations, the 
 65.25  project shall be extended to June 30, 2003. 
 65.26     (f) By January 15, 2003, the commission shall explore 
 65.27  applications of the project to other populations or geographic 
 65.28  areas and describe expansion efforts, including barriers to 
 65.29  expansion, and report to the commissioner. 
 65.30     Sec. 44.  Minnesota Statutes 2000, section 256B.0951, 
 65.31  subdivision 4, is amended to read: 
 65.32     Subd. 4.  [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF 
 65.33  LICENSING STANDARDS.] The commission may recommend to the 
 65.34  commissioners of human services and health variances from the 
 65.35  standards governing licensure of programs for persons with 
 65.36  developmental disabilities in order to improve the quality of 
 65.37  services by implementing an alternative developmental 
 66.1   disabilities licensing system if the commission determines that 
 66.2   the alternative licensing system does not negatively affect the 
 66.3   health or safety of persons being served by the licensed program 
 66.4   nor compromise the qualifications of staff to provide services. 
 66.5      Sec. 45.  Minnesota Statutes 2000, section 256B.0951, 
 66.6   subdivision 5, is amended to read: 
 66.7      Subd. 5.  [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The 
 66.8   safety standards, rights, or procedural protections under 
 66.9   sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 
 66.10  3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2) 
 66.11  and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, 
 66.12  subdivisions 1b, clause (7), and 10; 626.556; 626.557, and 
 66.13  procedures for the monitoring of psychotropic medications shall 
 66.14  not be varied under the alternative licensing system pilot 
 66.15  project.  The commission may make recommendations to the 
 66.16  commissioners of human services and health or to the legislature 
 66.17  regarding alternatives to or modifications of the rules and 
 66.18  procedures referenced in this subdivision. 
 66.19     Sec. 46.  Minnesota Statutes 2000, section 256B.0951, 
 66.20  subdivision 6, is amended to read: 
 66.21     Subd. 6.  [PROGRESS REPORT.] The commission shall submit a 
 66.22  progress report to the legislature on pilot project development 
 66.23  by January 15, 1998.  The report shall include recommendations 
 66.24  on any legislative changes necessary to improve cooperation 
 66.25  between the commission and the commissioners of human services 
 66.26  and health. 
 66.27     Sec. 47.  Minnesota Statutes 2000, section 256B.0951, 
 66.28  subdivision 7, is amended to read: 
 66.29     Subd. 7.  [WAIVER OF RULES.] The commissioner of health may 
 66.30  exempt residents of intermediate care facilities for persons 
 66.31  with mental retardation (ICFs/MR) who participate in the 
 66.32  three-year quality assurance pilot project established in 
 66.33  section 256B.095 from the requirements of Minnesota Rules, 
 66.34  chapter 4665, upon approval by the federal government of a 
 66.35  waiver of federal certification requirements for ICFs/MR.  The 
 66.36  commissioners of health and human services shall apply for any 
 67.1   necessary waivers as soon as practicable and shall submit the 
 67.2   concept paper to the federal government by June 1, 1998. 
 67.3      Sec. 48.  Minnesota Statutes 2000, section 256B.0951, is 
 67.4   amended by adding a subdivision to read: 
 67.5      Subd. 8.  [FEDERAL WAIVER.] The commissioner of human 
 67.6   services shall seek federal authority to waive provisions of 
 67.7   intermediate care facilities for persons with mental retardation 
 67.8   (ICFs/MR) regulations to enable the demonstration and evaluation 
 67.9   of the alternative quality assurance system for ICFs/MR under 
 67.10  the project. 
 67.11     Sec. 49.  Minnesota Statutes 2000, section 256B.0952, 
 67.12  subdivision 1, is amended to read: 
 67.13     Subdivision 1.  [NOTIFICATION.] By January 15, 1998, each 
 67.14  affected county shall notify the commission and the 
 67.15  commissioners of human services and health as to whether it 
 67.16  chooses to implement on July 1, 1998, the alternative licensing 
 67.17  system for the pilot project.  A county that does not implement 
 67.18  the alternative licensing system on July 1, 1998, may give 
 67.19  notice to the commission and the commissioners by January 15, 
 67.20  1999, or January 15, 2000, that it will implement the 
 67.21  alternative licensing system on the following July 1.  Region 10 
 67.22  counties may give notice to the commission and commissioners of 
 67.23  human services and health by March 15 to join or terminate 
 67.24  participation in the quality assurance alternative licensing 
 67.25  system on July 1 of that year for each year of the project.  A 
 67.26  county that implements choosing to participate in the 
 67.27  alternative licensing system commits to participate until June 
 67.28  30, 2001 2003.  Counties that choose to participate in the 
 67.29  quality assurance alternative licensing system prior to March 
 67.30  15, 2001, shall notify the commission and commissioners of human 
 67.31  services and health of their continued participation.  Counties 
 67.32  who continue to participate must commit to participate until 
 67.33  June 30, 2003.  
 67.34     Sec. 50.  Minnesota Statutes 2000, section 256B.0952, 
 67.35  subdivision 4, is amended to read: 
 67.36     Subd. 4.  [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 
 68.1   county or group of counties that chooses to participate in the 
 68.2   alternative licensing system shall designate a quality assurance 
 68.3   manager and shall establish quality assurance teams in 
 68.4   accordance with subdivision 5.  The manager shall recruit, 
 68.5   train, and assign duties to the quality assurance team members.  
 68.6   In assigning team members to conduct the quality assurance 
 68.7   process at a facility, program, or service, the manager shall 
 68.8   take into account the size of the service provider, the number 
 68.9   of services to be reviewed, the skills necessary for team 
 68.10  members to complete the process, and other relevant factors.  
 68.11  The manager shall ensure that no team member has a financial, 
 68.12  personal, or family relationship with the facility, program, or 
 68.13  service being reviewed or with any clients of the facility, 
 68.14  program, or service. 
 68.15     (b) Quality assurance teams shall report the findings of 
 68.16  their quality assurance reviews to the quality assurance manager.
 68.17  The quality assurance manager shall provide the report from the 
 68.18  quality assurance team to the county and, upon request, 
 68.19  commissioners of human services and health and a summary of the 
 68.20  report to the quality assurance review council.  
 68.21     Sec. 51.  Minnesota Statutes 2000, section 256B.0955, is 
 68.22  amended to read: 
 68.23     256B.0955 [DUTIES OF THE COMMISSIONER OF HUMAN SERVICES.] 
 68.24     (a) Effective July 1, 1998, the commissioner of human 
 68.25  services shall delegate authority to perform licensing functions 
 68.26  and activities, in accordance with section 245A.16, to counties 
 68.27  participating in the alternative licensing system.  The 
 68.28  commissioner shall not license or reimburse a facility, program, 
 68.29  or service for persons with developmental disabilities in a 
 68.30  county that participates in the alternative licensing system if 
 68.31  the commissioner has received from the appropriate county 
 68.32  notification that the facility, program, or service has been 
 68.33  reviewed by a quality assurance team and has failed to qualify 
 68.34  for licensure. 
 68.35     (b) The commissioner may conduct random licensing 
 68.36  inspections based on outcomes adopted under section 256B.0951 at 
 69.1   facilities, programs, and services governed by the alternative 
 69.2   licensing system.  The role of such random inspections shall be 
 69.3   to verify that the alternative licensing system protects the 
 69.4   safety and well-being of consumers and maintains the 
 69.5   availability of high-quality services for persons with 
 69.6   developmental disabilities.  
 69.7      (c) The commissioner shall provide technical assistance and 
 69.8   support or training to the alternative licensing system pilot 
 69.9   project. 
 69.10     Sec. 52.  Minnesota Statutes 2000, section 256B.49, is 
 69.11  amended by adding a subdivision to read: 
 69.12     Subd. 11.  [AUTHORITY.] (a) The commissioner is authorized 
 69.13  to apply for home and community-based service waivers, as 
 69.14  authorized under section 1915(c) of the Social Security Act to 
 69.15  serve persons under the age of 65 who are determined to require 
 69.16  the level of care provided in a nursing home and persons who 
 69.17  require the level of care provided in a hospital.  The 
 69.18  commissioner shall apply for the home and community-based 
 69.19  waivers in order to:  (i) promote the support of persons with 
 69.20  disabilities in the most integrated settings; (ii) expand the 
 69.21  availability of services for persons who are eligible for 
 69.22  medical assistance; (iii) promote cost-effective options to 
 69.23  institutional care; and (iv) obtain federal financial 
 69.24  participation.  
 69.25     (b) The provision of waivered services to medical 
 69.26  assistance recipients with disabilities shall comply with the 
 69.27  requirements outlined in the federally approved applications for 
 69.28  home and community-based services and subsequent amendments, 
 69.29  including provision of services according to a service plan 
 69.30  designated to meet the needs of the individual.  For purposes of 
 69.31  this section, the approved home and community-based application 
 69.32  is considered the necessary federal requirement. 
 69.33     (c) The commissioner shall seek approval, as authorized 
 69.34  under section 1915(c) of the Social Security Act, to allow 
 69.35  medical assistance eligibility under this section for children 
 69.36  under age 21 without deeming of parental income or assets. 
 70.1      (d) The commissioner shall seek approval, as authorized 
 70.2   under section 1915(c) of the Social Security Act, to allow 
 70.3   medical assistance eligibility under this section for 
 70.4   individuals under age 65 without deeming the spouse's income or 
 70.5   assets. 
 70.6      (e) Prior to submitting to the federal government any 
 70.7   proposed changes or amendments to federally approved 
 70.8   applications for home and community-based services, the 
 70.9   commissioner shall notify interested persons serving on 
 70.10  departmental advisory groups and task forces and persons who 
 70.11  have requested to be notified. 
 70.12     Sec. 53.  Minnesota Statutes 2000, section 256B.49, is 
 70.13  amended by adding a subdivision to read: 
 70.14     Subd. 12.  [INFORMED CHOICE.] Persons who are determined 
 70.15  likely to require the level of care provided in a nursing 
 70.16  facility or hospital shall be informed of the home and 
 70.17  community-based support alternatives to the provision of 
 70.18  inpatient hospital services or nursing facility services.  Each 
 70.19  person must be given the choice of either institutional or home 
 70.20  and community-based services using the provisions described in 
 70.21  section 256B.77, subdivision 2, paragraph (p). 
 70.22     Sec. 54.  Minnesota Statutes 2000, section 256B.49, is 
 70.23  amended by adding a subdivision to read: 
 70.24     Subd. 13.  [CASE MANAGEMENT.] (a) Each recipient of a home 
 70.25  and community-based waiver shall be provided case management 
 70.26  services by qualified vendors as described in the federally 
 70.27  approved waiver application.  The case management service 
 70.28  activities provided will include: 
 70.29     (1) assessing the needs of the individual within 20 working 
 70.30  days of a recipient's request; 
 70.31     (2) developing the written individual service plan within 
 70.32  ten working days after the assessment is completed; 
 70.33     (3) informing the recipient or the recipient's legal 
 70.34  guardian or conservator of service options; 
 70.35     (4) assisting the recipient in the identification of 
 70.36  potential service providers; 
 71.1      (5) assisting the recipient to access services; 
 71.2      (6) coordinating, evaluating, and monitoring of the 
 71.3   services identified in the service plan; 
 71.4      (7) completing the annual reviews of the service plan; and 
 71.5      (8) informing the recipient or legal representative of the 
 71.6   right to have assessments completed and service plans developed 
 71.7   within specified time periods, and to appeal county action or 
 71.8   inaction under section 256.045, subdivision 3. 
 71.9      (b) The case manager may delegate certain aspects of the 
 71.10  case management service activities to another individual 
 71.11  provided there is oversight by the case manager.  The case 
 71.12  manager may not delegate those aspects which require 
 71.13  professional judgment including assessments, reassessments, and 
 71.14  care plan development. 
 71.15     Sec. 55.  Minnesota Statutes 2000, section 256B.49, is 
 71.16  amended by adding a subdivision to read: 
 71.17     Subd. 14.  [ASSESSMENT AND REASSESSMENT.] (a) Assessments 
 71.18  of each recipient's strengths, informal support systems, and 
 71.19  need for services shall be completed within 20 working days of 
 71.20  the recipient's request.  Reassessment of each recipient's 
 71.21  strengths, support systems, and need for services shall be 
 71.22  conducted at least every 12 months and at other times when there 
 71.23  has been a significant change in the recipient's functioning. 
 71.24     (b) Persons with mental retardation or a related condition 
 71.25  who apply for services under the nursing facility level waiver 
 71.26  programs shall be screened for the appropriate level of care 
 71.27  according to section 256B.092. 
 71.28     (c) Recipients who are found eligible for home and 
 71.29  community-based services under this section before their 65th 
 71.30  birthday may remain eligible for these services after their 65th 
 71.31  birthday if they continue to meet all other eligibility factors. 
 71.32     Sec. 56.  Minnesota Statutes 2000, section 256B.49, is 
 71.33  amended by adding a subdivision to read: 
 71.34     Subd. 15.  [INDIVIDUALIZED SERVICE PLAN.] Each recipient of 
 71.35  home and community-based waivered services shall be provided a 
 71.36  copy of the written service plan which: 
 72.1      (1) is developed and signed by the recipient within ten 
 72.2   working days of the completion of the assessment; 
 72.3      (2) meets the assessed needs of the recipient; 
 72.4      (3) reasonably ensures the health and safety of the 
 72.5   recipient; 
 72.6      (4) promotes independence; 
 72.7      (5) allows for services to be provided in the most 
 72.8   integrated settings; and 
 72.9      (6) provides for an informed choice, as defined in section 
 72.10  256B.77, subdivision 2, paragraph (p), of service and support 
 72.11  providers. 
 72.12     Sec. 57.  Minnesota Statutes 2000, section 256B.49, is 
 72.13  amended by adding a subdivision to read: 
 72.14     Subd. 16.  [SERVICES AND SUPPORTS.] Services and supports 
 72.15  included in the home and community-based waivers for persons 
 72.16  with disabilities shall meet the requirements set out in United 
 72.17  States Code, title 42, section 1396n.  The services and 
 72.18  supports, which are offered as alternatives to institutional 
 72.19  care, shall promote consumer choice, community inclusion, 
 72.20  self-sufficiency, and self-determination.  Beginning January 1, 
 72.21  2003, the commissioner shall simplify and improve access to home 
 72.22  and community-based services, to the extent possible, through 
 72.23  the establishment of a common service menu that is available to 
 72.24  eligible recipients regardless of age, disability type, or 
 72.25  waiver program.  Consumer-directed community support services 
 72.26  shall be offered as an option to all persons eligible for 
 72.27  services under subdivision 11 by January 1, 2002.  Services and 
 72.28  supports shall be arranged and provided consistent with 
 72.29  individualized written plans of care for eligible waiver 
 72.30  recipients. 
 72.31     Sec. 58.  Minnesota Statutes 2000, section 256B.49, is 
 72.32  amended by adding a subdivision to read: 
 72.33     Subd. 17.  [COST OF SERVICES AND SUPPORTS.] (a) The 
 72.34  commissioner shall ensure that the average per capita 
 72.35  expenditures estimated in any fiscal year for home and 
 72.36  community-based waiver recipients does not exceed the average 
 73.1   per capita expenditures that would have been made to provide 
 73.2   institutional services for recipients in the absence of the 
 73.3   waiver. 
 73.4      (b) The commissioner shall implement on January 1, 2002, 
 73.5   one or more aggregate, need-based methods for allocating to 
 73.6   local agencies the home and community-based waivered service 
 73.7   resources available to support recipients with disabilities in 
 73.8   need of the level of care provided in a nursing facility or a 
 73.9   hospital.  The commissioner shall allocate resources to single 
 73.10  counties and county partnerships in a manner that reflects 
 73.11  consideration of: 
 73.12     (1) an incentive-based payment process for achieving 
 73.13  outcomes; 
 73.14     (2) the need for a state-level risk pool; 
 73.15     (3) the need for retention of management responsibility at 
 73.16  the state agency level; and 
 73.17     (4) a phase-in strategy as appropriate. 
 73.18     (c) Until the allocation methods described in paragraph (b) 
 73.19  are implemented, the annual allowable reimbursement level of 
 73.20  home and community-based waiver services shall be the greater of:
 73.21     (1) the statewide average payment amount which the 
 73.22  recipient is assigned under the waiver reimbursement system in 
 73.23  place on June 30, 2001, modified by the percentage of any 
 73.24  provider rate increase appropriated for home and community-based 
 73.25  services; or 
 73.26     (2) an amount approved by the commissioner based on the 
 73.27  recipient's extraordinary needs that cannot be met within the 
 73.28  current allowable reimbursement level.  The increased 
 73.29  reimbursement level must be necessary to allow the recipient to 
 73.30  be discharged from an institution or to prevent imminent 
 73.31  placement in an institution.  The additional reimbursement may 
 73.32  be used to secure environmental modifications; assistive 
 73.33  technology and equipment; and increased costs for supervision, 
 73.34  training, and support services necessary to address the 
 73.35  recipient's extraordinary needs.  The commissioner may approve 
 73.36  an increased reimbursement level for up to one year of the 
 74.1   recipient's relocation from an institution or up to six months 
 74.2   of a determination that a current waiver recipient is at 
 74.3   imminent risk of being placed in an institution. 
 74.4      (d) Beginning July 1, 2001, medically necessary private 
 74.5   duty nursing services will be authorized under this section as 
 74.6   complex and regular care according to section 256B.0627.  The 
 74.7   rate established by the commissioner for registered nurse or 
 74.8   licensed practical nurse services under any home and 
 74.9   community-based waiver as of January 1, 2001, shall not be 
 74.10  reduced. 
 74.11     Sec. 59.  Minnesota Statutes 2000, section 256B.49, is 
 74.12  amended by adding a subdivision to read: 
 74.13     Subd. 18.  [PAYMENTS.] The commissioner shall reimburse 
 74.14  approved vendors from the medical assistance account for the 
 74.15  costs of providing home and community-based services to eligible 
 74.16  recipients using the invoice processing procedures of the 
 74.17  Medicaid management information system (MMIS).  Recipients will 
 74.18  be screened and authorized for services according to the 
 74.19  federally approved waiver application and its subsequent 
 74.20  amendments. 
 74.21     Sec. 60.  Minnesota Statutes 2000, section 256B.49, is 
 74.22  amended by adding a subdivision to read: 
 74.23     Subd. 19.  [HEALTH AND WELFARE.] The commissioner of human 
 74.24  services shall take the necessary safeguards to protect the 
 74.25  health and welfare of individuals provided services under the 
 74.26  waiver. 
 74.27     Sec. 61.  Minnesota Statutes 2000, section 256B.5012, is 
 74.28  amended by adding a subdivision to read: 
 74.29     Subd. 4.  [FACILITY RATE INCREASES EFFECTIVE JANUARY 1, 
 74.30  2003.] For the rate year beginning January 1, 2003, for 
 74.31  intermediate care facilities reimbursed under this section, the 
 74.32  commissioner shall increase the total payment rate in effect for 
 74.33  each facility on December 31, 2002, by 2.0 percent.  This 
 74.34  increase shall be incorporated into ongoing facility per diems 
 74.35  as part of the permanent total payment rate. 
 74.36     Sec. 62.  Minnesota Statutes 2000, section 256D.35, is 
 75.1   amended by adding a subdivision to read: 
 75.2      Subd. 11a.  [INSTITUTION.] "Institution" means a hospital, 
 75.3   consistent with Code of Federal Regulations, title 42, section 
 75.4   440.10; regional treatment center inpatient services, consistent 
 75.5   with section 245.474; a nursing facility; and an intermediate 
 75.6   care facility for persons with mental retardation. 
 75.7      Sec. 63.  Minnesota Statutes 2000, section 256D.35, is 
 75.8   amended by adding a subdivision to read: 
 75.9      Subd. 18a.  [SHELTER COSTS.] "Shelter costs" means rent, 
 75.10  manufactured home lot rentals; monthly principal, interest, 
 75.11  insurance premiums, and property taxes due for mortgages or 
 75.12  contract for deed costs; costs for utilities, including heating, 
 75.13  cooling, electricity, water, and sewerage; garbage collection 
 75.14  fees; and the basic service fee for one telephone. 
 75.15     Sec. 64.  Minnesota Statutes 2000, section 256D.44, 
 75.16  subdivision 5, is amended to read: 
 75.17     Subd. 5.  [SPECIAL NEEDS.] In addition to the state 
 75.18  standards of assistance established in subdivisions 1 to 4, 
 75.19  payments are allowed for the following special needs of 
 75.20  recipients of Minnesota supplemental aid who are not residents 
 75.21  of a nursing home, a regional treatment center, or a group 
 75.22  residential housing facility. 
 75.23     (a) The county agency shall pay a monthly allowance for 
 75.24  medically prescribed diets payable under the Minnesota family 
 75.25  investment program if the cost of those additional dietary needs 
 75.26  cannot be met through some other maintenance benefit.  
 75.27     (b) Payment for nonrecurring special needs must be allowed 
 75.28  for necessary home repairs or necessary repairs or replacement 
 75.29  of household furniture and appliances using the payment standard 
 75.30  of the AFDC program in effect on July 16, 1996, for these 
 75.31  expenses, as long as other funding sources are not available.  
 75.32     (c) A fee for guardian or conservator service is allowed at 
 75.33  a reasonable rate negotiated by the county or approved by the 
 75.34  court.  This rate shall not exceed five percent of the 
 75.35  assistance unit's gross monthly income up to a maximum of $100 
 75.36  per month.  If the guardian or conservator is a member of the 
 76.1   county agency staff, no fee is allowed. 
 76.2      (d) The county agency shall continue to pay a monthly 
 76.3   allowance of $68 for restaurant meals for a person who was 
 76.4   receiving a restaurant meal allowance on June 1, 1990, and who 
 76.5   eats two or more meals in a restaurant daily.  The allowance 
 76.6   must continue until the person has not received Minnesota 
 76.7   supplemental aid for one full calendar month or until the 
 76.8   person's living arrangement changes and the person no longer 
 76.9   meets the criteria for the restaurant meal allowance, whichever 
 76.10  occurs first. 
 76.11     (e) A fee of ten percent of the recipient's gross income or 
 76.12  $25, whichever is less, is allowed for representative payee 
 76.13  services provided by an agency that meets the requirements under 
 76.14  SSI regulations to charge a fee for representative payee 
 76.15  services.  This special need is available to all recipients of 
 76.16  Minnesota supplemental aid regardless of their living 
 76.17  arrangement.  
 76.18     (f) Notwithstanding the language in this subdivision, an 
 76.19  amount equal to the maximum allotment authorized by the federal 
 76.20  Food Stamp Program for a single individual which is in effect on 
 76.21  the first day of January of the previous year will be added to 
 76.22  the standards of assistance established in subdivisions 1 to 4 
 76.23  for individuals under the age of 65 who are relocating from an 
 76.24  institution and who are shelter needy.  An eligible individual 
 76.25  who receives this benefit prior to age 65 may continue to 
 76.26  receive the benefit after the age of 65. 
 76.27     "Shelter needy" means that the assistance unit incurs 
 76.28  monthly shelter costs that exceed 40 percent of the assistance 
 76.29  unit's gross income before the application of this special needs 
 76.30  standard.  "Gross income" for the purposes of this section is 
 76.31  the applicant's or recipient's income as defined in section 
 76.32  256D.35, subdivision 10, or the standard specified in 
 76.33  subdivision 3, whichever is greater.  A recipient of a federal 
 76.34  or state housing subsidy, that limits shelter costs to a 
 76.35  percentage of gross income, shall not be considered shelter 
 76.36  needy for purposes of this paragraph. 
 77.1      Sec. 65.  [SEMI-INDEPENDENT LIVING SERVICES (SILS) STUDY.] 
 77.2      The commissioner of human services, in consultation with 
 77.3   county representatives and other interested persons, shall 
 77.4   develop recommendations revising the funding methodology for 
 77.5   SILS as defined in Minnesota Statutes, section 252.275, 
 77.6   subdivisions 3, 4, 4b, and 4c, and report by January 15, 2002, 
 77.7   to the chair of the house of representatives health and human 
 77.8   services finance committee and the chair of the senate health, 
 77.9   human services and corrections budget division. 
 77.10     Sec. 66.  [WAIVER REQUEST REGARDING SPOUSAL INCOME.] 
 77.11     By September 1, 2001, the commissioner of human services 
 77.12  shall seek federal approval to allow recipients of home and 
 77.13  community-based waivers authorized under Minnesota Statutes, 
 77.14  section 256B.49, to choose either a waiver of deeming of spousal 
 77.15  income or the spousal impoverishment protections authorized 
 77.16  under United States Code, title 42, section 1396r-5, with the 
 77.17  addition of the group residential housing rate set according to 
 77.18  Minnesota Statutes, section 256I.03, subdivision 5, to the 
 77.19  personal needs allowance authorized by Minnesota Statutes, 
 77.20  section 256B.0575. 
 77.21     Sec. 67.  [GRANTS TO PROVIDE BRAIN INJURY SUPPORT.] 
 77.22     Subdivision 1.  [GRANTS.] Within the limits of the 
 77.23  appropriations made specifically for this purpose, the 
 77.24  commissioner of health shall make grants of up to $300,000 to 
 77.25  nonprofit corporations to continue a pilot project that provides 
 77.26  information, connects to community resources, and provides 
 77.27  support and problem solving on an ongoing basis to individuals 
 77.28  with traumatic brain injuries.  
 77.29     Subd. 2.  [REPORT.] The commissioner shall prepare a report 
 77.30  identifying the results of the pilot project and making 
 77.31  recommendations on continuation of the project.  The report must 
 77.32  be forwarded to the legislature no later than January 15, 2004. 
 77.33     Sec. 68.  [APPROPRIATION.] 
 77.34     $300,000 is appropriated from the general fund to the 
 77.35  commissioner of health for the purpose of section 67, to be 
 77.36  available until June 30, 2003. 
 78.1      Sec. 69.  [REPEALER.] 
 78.2      (a) Minnesota Statutes 2000, sections 145.9245; 256.476, 
 78.3   subdivision 7; 256B.0912; 256B.0915, subdivisions 3a, 3b, and 
 78.4   3c; 256B.49, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10, are 
 78.5   repealed. 
 78.6      (b) Minnesota Rules, parts 9505.2455; 9505.2458; 9505.2460; 
 78.7   9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480; 
 78.8   9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496; 
 78.9   9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025; 
 78.10  9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085; 
 78.11  9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530; 
 78.12  9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560; 
 78.13  9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600; 
 78.14  9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626; 
 78.15  9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650; 
 78.16  9505.3660; and 9505.3670, are repealed.