1.1                          A bill for an act 
  1.2             relating to human services; making changes to 
  1.3             continuing care programs; amending Minnesota Statutes 
  1.4             2000, sections 245.462, subdivision 4; 245.4871, 
  1.5             subdivision 4; Minnesota Statutes 2001 Supplement, 
  1.6             sections 256B.0627, subdivision 10; 256B.0911, 
  1.7             subdivisions 4b, 4d; 256B.0913, subdivision 5; 
  1.8             256B.0915, subdivision 3; 256B.0924, subdivision 6; 
  1.9             256B.0951, subdivisions 7, 8; 256B.437, subdivision 6. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 2000, section 245.462, 
  1.12  subdivision 4, is amended to read: 
  1.13     Subd. 4.  [CASE MANAGEMENT SERVICE PROVIDER.] (a) "Case 
  1.14  management service provider" means a case manager or case 
  1.15  manager associate employed by the county or other entity 
  1.16  authorized by the county board to provide case management 
  1.17  services specified in section 245.4711.  
  1.18     (b) A case manager must: 
  1.19     (1) be skilled in the process of identifying and assessing 
  1.20  a wide range of client needs; 
  1.21     (2) be knowledgeable about local community resources and 
  1.22  how to use those resources for the benefit of the client; 
  1.23     (3) have a bachelor's degree in one of the behavioral 
  1.24  sciences or related fields including, but not limited to, social 
  1.25  work, psychology, or nursing from an accredited college or 
  1.26  university or meet the requirements of paragraph (c); and 
  1.27     (4) meet the supervision and continuing education 
  2.1   requirements described in paragraphs (d), (e), and (f), as 
  2.2   applicable.  
  2.3      (c) Case managers without a bachelor's degree must meet one 
  2.4   of the requirements in clauses (1) to (3):  
  2.5      (1) have three or four years of experience as a case 
  2.6   manager associate as defined in this section; 
  2.7      (2) be a registered nurse without a bachelor's degree and 
  2.8   have a combination of specialized training in psychiatry and 
  2.9   work experience consisting of community interaction and 
  2.10  involvement or community discharge planning in a mental health 
  2.11  setting totaling three years; or 
  2.12     (3) be a person who qualified as a case manager under the 
  2.13  1998 department of human service waiver provision and meet the 
  2.14  continuing education and mentoring requirements in this section. 
  2.15     (d) A case manager with at least 2,000 hours of supervised 
  2.16  experience in the delivery of services to adults with mental 
  2.17  illness must receive regular ongoing supervision and clinical 
  2.18  supervision totaling 38 hours per year of which at least one 
  2.19  hour per month must be clinical supervision regarding individual 
  2.20  service delivery with a case management supervisor.  The 
  2.21  remaining 26 hours of supervision may be provided by a case 
  2.22  manager with two years of experience.  Group supervision may not 
  2.23  constitute more than one-half of the required supervision 
  2.24  hours.  Clinical supervision must be documented in the client 
  2.25  record. 
  2.26     (e) A case manager without 2,000 hours of supervised 
  2.27  experience in the delivery of services to adults with mental 
  2.28  illness must: 
  2.29     (1) receive clinical supervision regarding individual 
  2.30  service delivery from a mental health professional at least one 
  2.31  hour per week until the requirement of 2,000 hours of experience 
  2.32  is met; and 
  2.33     (2) complete 40 hours of training approved by the 
  2.34  commissioner in case management skills and the characteristics 
  2.35  and needs of adults with serious and persistent mental illness.  
  2.36     (f) A case manager who is not licensed, registered, or 
  3.1   certified by a health-related licensing board must receive 30 
  3.2   hours of continuing education and training in mental illness and 
  3.3   mental health services annually every two years. 
  3.4      (g) A case manager associate (CMA) must: 
  3.5      (1) work under the direction of a case manager or case 
  3.6   management supervisor; 
  3.7      (2) be at least 21 years of age; 
  3.8      (3) have at least a high school diploma or its equivalent; 
  3.9   and 
  3.10     (4) meet one of the following criteria: 
  3.11     (i) have an associate of arts degree in one of the 
  3.12  behavioral sciences or human services; 
  3.13     (ii) be a registered nurse without a bachelor's degree; 
  3.14     (iii) within the previous ten years, have three years of 
  3.15  life experience with serious and persistent mental illness as 
  3.16  defined in section 245.462, subdivision 20; or as a child had 
  3.17  severe emotional disturbance as defined in section 245.4871, 
  3.18  subdivision 6; or have three years life experience as a primary 
  3.19  caregiver to an adult with serious and persistent mental illness 
  3.20  within the previous ten years; 
  3.21     (iv) have 6,000 hours work experience as a nondegreed state 
  3.22  hospital technician; or 
  3.23     (v) be a mental health practitioner as defined in section 
  3.24  245.462, subdivision 17, clause (2). 
  3.25     Individuals meeting one of the criteria in items (i) to 
  3.26  (iv), may qualify as a case manager after four years of 
  3.27  supervised work experience as a case manager associate.  
  3.28  Individuals meeting the criteria in item (v), may qualify as a 
  3.29  case manager after three years of supervised experience as a 
  3.30  case manager associate. 
  3.31     (h) A case management associate must meet the following 
  3.32  supervision, mentoring, and continuing education requirements:  
  3.33     (1) have 40 hours of preservice training described under 
  3.34  paragraph (e), clause (2); 
  3.35     (2) receive at least 40 hours of continuing education in 
  3.36  mental illness and mental health services annually; and 
  4.1      (3) receive at least five hours of mentoring per week from 
  4.2   a case management mentor.  
  4.3   A "case management mentor" means a qualified, practicing case 
  4.4   manager or case management supervisor who teaches or advises and 
  4.5   provides intensive training and clinical supervision to one or 
  4.6   more case manager associates.  Mentoring may occur while 
  4.7   providing direct services to consumers in the office or in the 
  4.8   field and may be provided to individuals or groups of case 
  4.9   manager associates.  At least two mentoring hours per week must 
  4.10  be individual and face-to-face. 
  4.11     (i) A case management supervisor must meet the criteria for 
  4.12  mental health professionals, as specified in section 245.462, 
  4.13  subdivision 18. 
  4.14     (j) An immigrant who does not have the qualifications 
  4.15  specified in this subdivision may provide case management 
  4.16  services to adult immigrants with serious and persistent mental 
  4.17  illness who are members of the same ethnic group as the case 
  4.18  manager if the person:  
  4.19     (1) is currently enrolled in and is actively pursuing 
  4.20  credits toward the completion of a bachelor's degree in one of 
  4.21  the behavioral sciences or a related field including, but not 
  4.22  limited to, social work, psychology, or nursing from an 
  4.23  accredited college or university; 
  4.24     (2) completes 40 hours of training as specified in this 
  4.25  subdivision; and 
  4.26     (3) receives clinical supervision at least once a week 
  4.27  until the requirements of this subdivision are met. 
  4.28     Sec. 2.  Minnesota Statutes 2000, section 245.4871, 
  4.29  subdivision 4, is amended to read: 
  4.30     Subd. 4.  [CASE MANAGEMENT SERVICE PROVIDER.] (a) "Case 
  4.31  management service provider" means a case manager or case 
  4.32  manager associate employed by the county or other entity 
  4.33  authorized by the county board to provide case management 
  4.34  services specified in subdivision 3 for the child with severe 
  4.35  emotional disturbance and the child's family.  
  4.36     (b) A case manager must: 
  5.1      (1) have experience and training in working with children; 
  5.2      (2) have at least a bachelor's degree in one of the 
  5.3   behavioral sciences or a related field including, but not 
  5.4   limited to, social work, psychology, or nursing from an 
  5.5   accredited college or university or meet the requirements of 
  5.6   paragraph (d); 
  5.7      (3) have experience and training in identifying and 
  5.8   assessing a wide range of children's needs; 
  5.9      (4) be knowledgeable about local community resources and 
  5.10  how to use those resources for the benefit of children and their 
  5.11  families; and 
  5.12     (5) meet the supervision and continuing education 
  5.13  requirements of paragraphs (e), (f), and (g), as applicable. 
  5.14     (c) A case manager may be a member of any professional 
  5.15  discipline that is part of the local system of care for children 
  5.16  established by the county board. 
  5.17     (d) A case manager without a bachelor's degree must meet 
  5.18  one of the requirements in clauses (1) to (3):  
  5.19     (1) have three or four years of experience as a case 
  5.20  manager associate; 
  5.21     (2) be a registered nurse without a bachelor's degree who 
  5.22  has a combination of specialized training in psychiatry and work 
  5.23  experience consisting of community interaction and involvement 
  5.24  or community discharge planning in a mental health setting 
  5.25  totaling three years; or 
  5.26     (3) be a person who qualified as a case manager under the 
  5.27  1998 department of human services waiver provision and meets the 
  5.28  continuing education, supervision, and mentoring requirements in 
  5.29  this section. 
  5.30     (e) A case manager with at least 2,000 hours of supervised 
  5.31  experience in the delivery of mental health services to children 
  5.32  must receive regular ongoing supervision and clinical 
  5.33  supervision totaling 38 hours per year, of which at least one 
  5.34  hour per month must be clinical supervision regarding individual 
  5.35  service delivery with a case management supervisor.  The other 
  5.36  26 hours of supervision may be provided by a case manager with 
  6.1   two years of experience.  Group supervision may not constitute 
  6.2   more than one-half of the required supervision hours. 
  6.3      (f) A case manager without 2,000 hours of supervised 
  6.4   experience in the delivery of mental health services to children 
  6.5   with emotional disturbance must: 
  6.6      (1) begin 40 hours of training approved by the commissioner 
  6.7   of human services in case management skills and in the 
  6.8   characteristics and needs of children with severe emotional 
  6.9   disturbance before beginning to provide case management 
  6.10  services; and 
  6.11     (2) receive clinical supervision regarding individual 
  6.12  service delivery from a mental health professional at least one 
  6.13  hour each week until the requirement of 2,000 hours of 
  6.14  experience is met. 
  6.15     (g) A case manager who is not licensed, registered, or 
  6.16  certified by a health-related licensing board must receive 30 
  6.17  hours of continuing education and training in severe emotional 
  6.18  disturbance and mental health services annually every two years. 
  6.19     (h) Clinical supervision must be documented in the child's 
  6.20  record.  When the case manager is not a mental health 
  6.21  professional, the county board must provide or contract for 
  6.22  needed clinical supervision. 
  6.23     (i) The county board must ensure that the case manager has 
  6.24  the freedom to access and coordinate the services within the 
  6.25  local system of care that are needed by the child. 
  6.26     (j) A case manager associate (CMA) must: 
  6.27     (1) work under the direction of a case manager or case 
  6.28  management supervisor; 
  6.29     (2) be at least 21 years of age; 
  6.30     (3) have at least a high school diploma or its equivalent; 
  6.31  and 
  6.32     (4) meet one of the following criteria: 
  6.33     (i) have an associate of arts degree in one of the 
  6.34  behavioral sciences or human services; 
  6.35     (ii) be a registered nurse without a bachelor's degree; 
  6.36     (iii) have three years of life experience as a primary 
  7.1   caregiver to a child with serious emotional disturbance as 
  7.2   defined in section 245.4871, subdivision 6, within the previous 
  7.3   ten years; 
  7.4      (iv) have 6,000 hours work experience as a nondegreed state 
  7.5   hospital technician; or 
  7.6      (v) be a mental health practitioner as defined in 
  7.7   subdivision 26, clause (2). 
  7.8      Individuals meeting one of the criteria in items (i) to 
  7.9   (iv) may qualify as a case manager after four years of 
  7.10  supervised work experience as a case manager associate.  
  7.11  Individuals meeting the criteria in item (v) may qualify as a 
  7.12  case manager after three years of supervised experience as a 
  7.13  case manager associate. 
  7.14     (k) Case manager associates must meet the following 
  7.15  supervision, mentoring, and continuing education requirements; 
  7.16     (1) have 40 hours of preservice training described under 
  7.17  paragraph (f), clause (1); 
  7.18     (2) receive at least 40 hours of continuing education in 
  7.19  severe emotional disturbance and mental health service annually; 
  7.20  and 
  7.21     (3) receive at least five hours of mentoring per week from 
  7.22  a case management mentor.  A "case management mentor" means a 
  7.23  qualified, practicing case manager or case management supervisor 
  7.24  who teaches or advises and provides intensive training and 
  7.25  clinical supervision to one or more case manager associates.  
  7.26  Mentoring may occur while providing direct services to consumers 
  7.27  in the office or in the field and may be provided to individuals 
  7.28  or groups of case manager associates.  At least two mentoring 
  7.29  hours per week must be individual and face-to-face. 
  7.30     (l) A case management supervisor must meet the criteria for 
  7.31  a mental health professional as specified in section 245.4871, 
  7.32  subdivision 27. 
  7.33     (m) An immigrant who does not have the qualifications 
  7.34  specified in this subdivision may provide case management 
  7.35  services to child immigrants with severe emotional disturbance 
  7.36  of the same ethnic group as the immigrant if the person:  
  8.1      (1) is currently enrolled in and is actively pursuing 
  8.2   credits toward the completion of a bachelor's degree in one of 
  8.3   the behavioral sciences or related fields at an accredited 
  8.4   college or university; 
  8.5      (2) completes 40 hours of training as specified in this 
  8.6   subdivision; and 
  8.7      (3) receives clinical supervision at least once a week 
  8.8   until the requirements of obtaining a bachelor's degree and 
  8.9   2,000 hours of supervised experience are met. 
  8.10     Sec. 3.  Minnesota Statutes 2001 Supplement, section 
  8.11  256B.0627, subdivision 10, is amended to read: 
  8.12     Subd. 10.  [FISCAL INTERMEDIARY OPTION AVAILABLE FOR 
  8.13  PERSONAL CARE ASSISTANT SERVICES.] (a) The commissioner may 
  8.14  allow a recipient of personal care assistant services to use a 
  8.15  fiscal intermediary to assist the recipient in paying and 
  8.16  accounting for medically necessary covered personal care 
  8.17  assistant services authorized in subdivision 4 and within the 
  8.18  payment parameters of subdivision 5.  Unless otherwise provided 
  8.19  in this subdivision, all other statutory and regulatory 
  8.20  provisions relating to personal care assistant services apply to 
  8.21  a recipient using the fiscal intermediary option. 
  8.22     (b) The recipient or responsible party shall: 
  8.23     (1) recruit, hire, and terminate a qualified professional, 
  8.24  if a qualified professional is requested by the recipient or 
  8.25  responsible party; 
  8.26     (2) verify and document the credentials of the qualified 
  8.27  professional, if a qualified professional is requested by the 
  8.28  recipient or responsible party; 
  8.29     (3) develop a service plan based on physician orders and 
  8.30  public health nurse assessment with the assistance of a 
  8.31  qualified professional, if a qualified professional is requested 
  8.32  by the recipient or responsible party, that addresses the health 
  8.33  and safety of the recipient; 
  8.34     (4) recruit, hire, and terminate the personal care 
  8.35  assistant; 
  8.36     (5) orient and train the personal care assistant with 
  9.1   assistance as needed from the qualified professional; 
  9.2      (6) supervise and evaluate the personal care assistant with 
  9.3   assistance as needed from the recipient's physician or the 
  9.4   qualified professional; 
  9.5      (7) monitor and verify in writing and report to the fiscal 
  9.6   intermediary the number of hours worked by the personal care 
  9.7   assistant and the qualified professional; and 
  9.8      (8) enter into a written agreement, as specified in 
  9.9   paragraph (f). 
  9.10     (c) The duties of the fiscal intermediary shall be to: 
  9.11     (1) bill the medical assistance program for personal care 
  9.12  assistant and qualified professional services; 
  9.13     (2) request and secure background checks on personal care 
  9.14  assistants and qualified professionals according to section 
  9.15  245A.04; 
  9.16     (3) pay the personal care assistant and qualified 
  9.17  professional based on actual hours of services provided; 
  9.18     (4) withhold and pay all applicable federal and state 
  9.19  taxes; 
  9.20     (5) verify and keep records of hours worked by the personal 
  9.21  care assistant and qualified professional; 
  9.22     (6) make the arrangements and pay unemployment insurance, 
  9.23  taxes, workers' compensation, liability insurance, and other 
  9.24  benefits, if any; 
  9.25     (7) enroll in the medical assistance program as a fiscal 
  9.26  intermediary; and 
  9.27     (8) enter into a written agreement as specified in 
  9.28  paragraph (f) before services are provided. 
  9.29     (d) The fiscal intermediary: 
  9.30     (1) may not be related to the recipient, qualified 
  9.31  professional, or the personal care assistant; 
  9.32     (2) must ensure arm's length transactions with the 
  9.33  recipient and personal care assistant; and 
  9.34     (3) shall be considered a joint employer of the personal 
  9.35  care assistant and qualified professional to the extent 
  9.36  specified in this section. 
 10.1      The fiscal intermediary or owners of the entity that 
 10.2   provides fiscal intermediary services under this subdivision 
 10.3   must pass a criminal background check as required in section 
 10.4   256B.0627, subdivision 1, paragraph (e). 
 10.5      (e) If the recipient or responsible party requests a 
 10.6   qualified professional, the qualified professional providing 
 10.7   assistance to the recipient shall meet the qualifications 
 10.8   specified in section 256B.0625, subdivision 19c.  The qualified 
 10.9   professional shall assist the recipient in developing and 
 10.10  revising a plan to meet the recipient's needs, as assessed by 
 10.11  the public health nurse.  In performing this function, the 
 10.12  qualified professional must visit the recipient in the 
 10.13  recipient's home at least once annually.  The qualified 
 10.14  professional must report any suspected abuse, neglect, or 
 10.15  financial exploitation of the recipient to the appropriate 
 10.16  authorities.  
 10.17     (f) The fiscal intermediary, recipient or responsible 
 10.18  party, personal care assistant, and qualified professional shall 
 10.19  enter into a written agreement before services are started.  The 
 10.20  agreement shall include: 
 10.21     (1) the duties of the recipient, qualified professional, 
 10.22  personal care assistant, and fiscal agent based on paragraphs 
 10.23  (a) to (e); 
 10.24     (2) the salary and benefits for the personal care assistant 
 10.25  and the qualified professional; 
 10.26     (3) the administrative fee of the fiscal intermediary and 
 10.27  services paid for with that fee, including background check 
 10.28  fees; 
 10.29     (4) procedures to respond to billing or payment complaints; 
 10.30  and 
 10.31     (5) procedures for hiring and terminating the personal care 
 10.32  assistant and the qualified professional. 
 10.33     (g) The rates paid for personal care assistant 
 10.34  services, shared care services, qualified professional services, 
 10.35  and fiscal intermediary services under this subdivision shall be 
 10.36  the same rates paid for personal care assistant services and 
 11.1   qualified professional services under subdivision 2 
 11.2   respectively.  Except for the administrative fee of the fiscal 
 11.3   intermediary specified in paragraph (f), the remainder of the 
 11.4   rates paid to the fiscal intermediary must be used to pay for 
 11.5   the salary and benefits for the personal care assistant or the 
 11.6   qualified professional. 
 11.7      (h) As part of the assessment defined in subdivision 1, the 
 11.8   following conditions must be met to use or continue use of a 
 11.9   fiscal intermediary: 
 11.10     (1) the recipient must be able to direct the recipient's 
 11.11  own care, or the responsible party for the recipient must be 
 11.12  readily available to direct the care of the personal care 
 11.13  assistant; 
 11.14     (2) the recipient or responsible party must be 
 11.15  knowledgeable of the health care needs of the recipient and be 
 11.16  able to effectively communicate those needs; 
 11.17     (3) a face-to-face assessment must be conducted by the 
 11.18  local county public health nurse at least annually, or when 
 11.19  there is a significant change in the recipient's condition or 
 11.20  change in the need for personal care assistant services; 
 11.21     (4) recipients who choose to use the shared care option as 
 11.22  specified in subdivision 8 must utilize the same fiscal 
 11.23  intermediary; and 
 11.24     the recipient cannot select the shared services option as 
 11.25  specified in subdivision 8; and 
 11.26     (5)  parties must be in compliance with the written 
 11.27  agreement specified in paragraph (f). 
 11.28     (i) The commissioner shall deny, revoke, or suspend the 
 11.29  authorization to use the fiscal intermediary option if: 
 11.30     (1) it has been determined by the qualified professional or 
 11.31  local county public health nurse that the use of this option 
 11.32  jeopardizes the recipient's health and safety; 
 11.33     (2) the parties have failed to comply with the written 
 11.34  agreement specified in paragraph (f); or 
 11.35     (3) the use of the option has led to abusive or fraudulent 
 11.36  billing for personal care assistant services.  
 12.1      The recipient or responsible party may appeal the 
 12.2   commissioner's action according to section 256.045.  The denial, 
 12.3   revocation, or suspension to use the fiscal intermediary option 
 12.4   shall not affect the recipient's authorized level of personal 
 12.5   care assistant services as determined in subdivision 5. 
 12.6      Sec. 4.  Minnesota Statutes 2001 Supplement, section 
 12.7   256B.0911, subdivision 4b, is amended to read: 
 12.8      Subd. 4b.  [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 
 12.9   Exemptions from the federal screening requirements outlined in 
 12.10  subdivision 4a, paragraphs (b) and (c), are limited to: 
 12.11     (1) a person who, having entered an acute care facility 
 12.12  from a certified nursing facility, is returning to a certified 
 12.13  nursing facility; and 
 12.14     (2) a person transferring from one certified nursing 
 12.15  facility in Minnesota to another certified nursing facility in 
 12.16  Minnesota; and 
 12.17     (3) a person, 21 years of age or older, who is admitted to 
 12.18  a nursing facility from a hospital after receiving acute 
 12.19  inpatient care at the hospital and whose admission to the 
 12.20  nursing facility meets the criteria outlined in the Code of 
 12.21  Federal Regulations, part 483.106, (b)(2). 
 12.22     (b) Persons who are exempt from preadmission screening for 
 12.23  purposes of level of care determination include: 
 12.24     (1) persons described in paragraph (a); 
 12.25     (2) an individual who has a contractual right to have 
 12.26  nursing facility care paid for indefinitely by the veterans' 
 12.27  administration; 
 12.28     (3) an individual enrolled in a demonstration project under 
 12.29  section 256B.69, subdivision 8, at the time of application to a 
 12.30  nursing facility; 
 12.31     (4) an individual currently being served under the 
 12.32  alternative care program or under a home and community-based 
 12.33  services waiver authorized under section 1915(c) of the federal 
 12.34  Social Security Act; and 
 12.35     (5) individuals admitted to a certified nursing facility 
 12.36  for a short-term stay, which is expected to be 14 days or less 
 13.1   in duration based upon a physician's certification, and who have 
 13.2   been assessed and approved for nursing facility admission within 
 13.3   the previous six months.  This exemption applies only if the 
 13.4   consultation team member determines at the time of the initial 
 13.5   assessment of the six-month period that it is appropriate to use 
 13.6   the nursing facility for short-term stays and that there is an 
 13.7   adequate plan of care for return to the home or community-based 
 13.8   setting.  If a stay exceeds 14 days, the individual must be 
 13.9   referred no later than the first county working day following 
 13.10  the 14th resident day for a screening, which must be completed 
 13.11  within five working days of the referral.  The payment 
 13.12  limitations in subdivision 7 apply to an individual found at 
 13.13  screening to not meet the level of care criteria for admission 
 13.14  to a certified nursing facility. 
 13.15     (c) Persons admitted to a Medicaid-certified nursing 
 13.16  facility from the community on an emergency basis as described 
 13.17  in paragraph (d) or from an acute care facility on a nonworking 
 13.18  day must be screened the first working day after admission. 
 13.19     (d) Emergency admission to a nursing facility prior to 
 13.20  screening is permitted when all of the following conditions are 
 13.21  met: 
 13.22     (1) a person is admitted from the community to a certified 
 13.23  nursing or certified boarding care facility during county 
 13.24  nonworking hours; 
 13.25     (2) a physician has determined that delaying admission 
 13.26  until preadmission screening is completed would adversely affect 
 13.27  the person's health and safety; 
 13.28     (3) there is a recent precipitating event that precludes 
 13.29  the client from living safely in the community, such as 
 13.30  sustaining an injury, sudden onset of acute illness, or a 
 13.31  caregiver's inability to continue to provide care; 
 13.32     (4) the attending physician has authorized the emergency 
 13.33  placement and has documented the reason that the emergency 
 13.34  placement is recommended; and 
 13.35     (5) the county is contacted on the first working day 
 13.36  following the emergency admission. 
 14.1   Transfer of a patient from an acute care hospital to a nursing 
 14.2   facility is not considered an emergency except for a person who 
 14.3   has received hospital services in the following situations: 
 14.4   hospital admission for observation, care in an emergency room 
 14.5   without hospital admission, or following hospital 24-hour bed 
 14.6   care. 
 14.7      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 14.8   following final enactment.  
 14.9      Sec. 5.  Minnesota Statutes 2001 Supplement, section 
 14.10  256B.0911, subdivision 4d, is amended to read: 
 14.11     Subd. 4d.  [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 
 14.12  YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 
 14.13  ensure that individuals with disabilities or chronic illness are 
 14.14  served in the most integrated setting appropriate to their needs 
 14.15  and have the necessary information to make informed choices 
 14.16  about home and community-based service options. 
 14.17     (b) Individuals under 65 years of age who are admitted to a 
 14.18  nursing facility from a hospital must be screened prior to 
 14.19  admission as outlined in subdivisions 4a through 4c. 
 14.20     (c) Individuals under 65 years of age who are admitted to 
 14.21  nursing facilities with only a telephone screening must receive 
 14.22  a face-to-face assessment from the long-term care consultation 
 14.23  team member of the county in which the facility is located or 
 14.24  from the recipient's county case manager within 20 working days 
 14.25  of admission. 
 14.26     (d) Individuals under 65 years of age who are admitted to a 
 14.27  nursing facility without preadmission screening according to the 
 14.28  exemption described in subdivision 4b, paragraph (a), clause 
 14.29  (3), and who remain in the facility longer than 30 days must 
 14.30  receive a face-to-face assessment within 40 days of admission.  
 14.31     (e) At the face-to-face assessment, the long-term care 
 14.32  consultation team member or county case manager must perform the 
 14.33  activities required under subdivision 3b. 
 14.34     (e) (f) For individuals under 21 years of age, a screening 
 14.35  interview which recommends nursing facility admission must be 
 14.36  face-to-face and approved by the commissioner before the 
 15.1   individual is admitted to the nursing facility. 
 15.2      (f) (g) In the event that an individual under 65 years of 
 15.3   age is admitted to a nursing facility on an emergency basis, the 
 15.4   county must be notified of the admission on the next working 
 15.5   day, and a face-to-face assessment as described in paragraph (c) 
 15.6   must be conducted within 20 working days of admission. 
 15.7      (g) (h) At the face-to-face assessment, the long-term care 
 15.8   consultation team member or the case manager must present 
 15.9   information about home and community-based options so the 
 15.10  individual can make informed choices.  If the individual chooses 
 15.11  home and community-based services, the long-term care 
 15.12  consultation team member or case manager must complete a written 
 15.13  relocation plan within 20 working days of the visit.  The plan 
 15.14  shall describe the services needed to move out of the facility 
 15.15  and a time line for the move which is designed to ensure a 
 15.16  smooth transition to the individual's home and community. 
 15.17     (h) (i) An individual under 65 years of age residing in a 
 15.18  nursing facility shall receive a face-to-face assessment at 
 15.19  least every 12 months to review the person's service choices and 
 15.20  available alternatives unless the individual indicates, in 
 15.21  writing, that annual visits are not desired.  In this case, the 
 15.22  individual must receive a face-to-face assessment at least once 
 15.23  every 36 months for the same purposes. 
 15.24     (i) (j) Notwithstanding the provisions of subdivision 6, 
 15.25  the commissioner may pay county agencies directly for 
 15.26  face-to-face assessments for individuals under 65 years of age 
 15.27  who are being considered for placement or residing in a nursing 
 15.28  facility. 
 15.29     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 15.30  following final enactment. 
 15.31     Sec. 6.  Minnesota Statutes 2001 Supplement, section 
 15.32  256B.0913, subdivision 5, is amended to read: 
 15.33     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
 15.34  Alternative care funding may be used for payment of costs of: 
 15.35     (1) adult foster care; 
 15.36     (2) adult day care; 
 16.1      (3) home health aide; 
 16.2      (4) homemaker services; 
 16.3      (5) personal care; 
 16.4      (6) case management; 
 16.5      (7) respite care; 
 16.6      (8) assisted living; 
 16.7      (9) residential care services; 
 16.8      (10) care-related supplies and equipment; 
 16.9      (11) meals delivered to the home; 
 16.10     (12) transportation; 
 16.11     (13) skilled nursing; 
 16.12     (14) chore services; 
 16.13     (15) companion services; 
 16.14     (16) nutrition services; 
 16.15     (17) training for direct informal caregivers; 
 16.16     (18) telemedicine devices to monitor recipients in their 
 16.17  own homes as an alternative to hospital care, nursing home care, 
 16.18  or home visits; 
 16.19     (19) other services which includes discretionary funds and 
 16.20  direct cash payments to clients, following approval by the 
 16.21  commissioner, subject to the provisions of paragraph (j).  Total 
 16.22  annual payments for "other services" for all clients within a 
 16.23  county may not exceed either ten 25 percent of that county's 
 16.24  annual alternative care program base allocation or $5,000, 
 16.25  whichever is greater.  In no case shall this amount exceed the 
 16.26  county's total annual alternative care program base allocation; 
 16.27  and 
 16.28     (20) environmental modifications. 
 16.29     (b) The county agency must ensure that the funds are not 
 16.30  used to supplant services available through other public 
 16.31  assistance or services programs. 
 16.32     (c) Unless specified in statute, the service definitions 
 16.33  and standards for alternative care services shall be the same as 
 16.34  the service definitions and standards specified in the federally 
 16.35  approved elderly waiver plan.  Except for the county agencies' 
 16.36  approval of direct cash payments to clients as described in 
 17.1   paragraph (j) or for a provider of supplies and equipment when 
 17.2   the monthly cost of the supplies and equipment is less than 
 17.3   $250, persons or agencies must be employed by or under a 
 17.4   contract with the county agency or the public health nursing 
 17.5   agency of the local board of health in order to receive funding 
 17.6   under the alternative care program.  Supplies and equipment may 
 17.7   be purchased from a vendor not certified to participate in the 
 17.8   Medicaid program if the cost for the item is less than that of a 
 17.9   Medicaid vendor.  
 17.10     (d) The adult foster care rate shall be considered a 
 17.11  difficulty of care payment and shall not include room and 
 17.12  board.  The adult foster care rate shall be negotiated between 
 17.13  the county agency and the foster care provider.  The alternative 
 17.14  care payment for the foster care service in combination with the 
 17.15  payment for other alternative care services, including case 
 17.16  management, must not exceed the limit specified in subdivision 
 17.17  4, paragraph (a), clause (6). 
 17.18     (e) Personal care services must meet the service standards 
 17.19  defined in the federally approved elderly waiver plan, except 
 17.20  that a county agency may contract with a client's relative who 
 17.21  meets the relative hardship waiver requirement as defined in 
 17.22  section 256B.0627, subdivision 4, paragraph (b), clause (10), to 
 17.23  provide personal care services if the county agency ensures 
 17.24  supervision of this service by a registered nurse or mental 
 17.25  health practitioner.  
 17.26     (f) For purposes of this section, residential care services 
 17.27  are services which are provided to individuals living in 
 17.28  residential care homes.  Residential care homes are currently 
 17.29  licensed as board and lodging establishments and are registered 
 17.30  with the department of health as providing special services 
 17.31  under section 157.17 and are not subject to registration under 
 17.32  chapter 144D.  Residential care services are defined as 
 17.33  "supportive services" and "health-related services."  
 17.34  "Supportive services" means the provision of up to 24-hour 
 17.35  supervision and oversight.  Supportive services includes:  (1) 
 17.36  transportation, when provided by the residential care home only; 
 18.1   (2) socialization, when socialization is part of the plan of 
 18.2   care, has specific goals and outcomes established, and is not 
 18.3   diversional or recreational in nature; (3) assisting clients in 
 18.4   setting up meetings and appointments; (4) assisting clients in 
 18.5   setting up medical and social services; (5) providing assistance 
 18.6   with personal laundry, such as carrying the client's laundry to 
 18.7   the laundry room.  Assistance with personal laundry does not 
 18.8   include any laundry, such as bed linen, that is included in the 
 18.9   room and board rate.  "Health-related services" are limited to 
 18.10  minimal assistance with dressing, grooming, and bathing and 
 18.11  providing reminders to residents to take medications that are 
 18.12  self-administered or providing storage for medications, if 
 18.13  requested.  Individuals receiving residential care services 
 18.14  cannot receive homemaking services funded under this section.  
 18.15     (g) For the purposes of this section, "assisted living" 
 18.16  refers to supportive services provided by a single vendor to 
 18.17  clients who reside in the same apartment building of three or 
 18.18  more units which are not subject to registration under chapter 
 18.19  144D and are licensed by the department of health as a class A 
 18.20  home care provider or a class E home care provider.  Assisted 
 18.21  living services are defined as up to 24-hour supervision, and 
 18.22  oversight, supportive services as defined in clause (1), 
 18.23  individualized home care aide tasks as defined in clause (2), 
 18.24  and individualized home management tasks as defined in clause 
 18.25  (3) provided to residents of a residential center living in 
 18.26  their units or apartments with a full kitchen and bathroom.  A 
 18.27  full kitchen includes a stove, oven, refrigerator, food 
 18.28  preparation counter space, and a kitchen utensil storage 
 18.29  compartment.  Assisted living services must be provided by the 
 18.30  management of the residential center or by providers under 
 18.31  contract with the management or with the county. 
 18.32     (1) Supportive services include:  
 18.33     (i) socialization, when socialization is part of the plan 
 18.34  of care, has specific goals and outcomes established, and is not 
 18.35  diversional or recreational in nature; 
 18.36     (ii) assisting clients in setting up meetings and 
 19.1   appointments; and 
 19.2      (iii) providing transportation, when provided by the 
 19.3   residential center only.  
 19.4      (2) Home care aide tasks means:  
 19.5      (i) preparing modified diets, such as diabetic or low 
 19.6   sodium diets; 
 19.7      (ii) reminding residents to take regularly scheduled 
 19.8   medications or to perform exercises; 
 19.9      (iii) household chores in the presence of technically 
 19.10  sophisticated medical equipment or episodes of acute illness or 
 19.11  infectious disease; 
 19.12     (iv) household chores when the resident's care requires the 
 19.13  prevention of exposure to infectious disease or containment of 
 19.14  infectious disease; and 
 19.15     (v) assisting with dressing, oral hygiene, hair care, 
 19.16  grooming, and bathing, if the resident is ambulatory, and if the 
 19.17  resident has no serious acute illness or infectious disease.  
 19.18  Oral hygiene means care of teeth, gums, and oral prosthetic 
 19.19  devices.  
 19.20     (3) Home management tasks means:  
 19.21     (i) housekeeping; 
 19.22     (ii) laundry; 
 19.23     (iii) preparation of regular snacks and meals; and 
 19.24     (iv) shopping.  
 19.25     Individuals receiving assisted living services shall not 
 19.26  receive both assisted living services and homemaking services.  
 19.27  Individualized means services are chosen and designed 
 19.28  specifically for each resident's needs, rather than provided or 
 19.29  offered to all residents regardless of their illnesses, 
 19.30  disabilities, or physical conditions.  Assisted living services 
 19.31  as defined in this section shall not be authorized in boarding 
 19.32  and lodging establishments licensed according to sections 
 19.33  157.011 and 157.15 to 157.22. 
 19.34     (h) For establishments registered under chapter 144D, 
 19.35  assisted living services under this section means either the 
 19.36  services described in paragraph (g) and delivered by a class E 
 20.1   home care provider licensed by the department of health or the 
 20.2   services described under section 144A.4605 and delivered by an 
 20.3   assisted living home care provider or a class A home care 
 20.4   provider licensed by the commissioner of health. 
 20.5      (i) Payment for assisted living services and residential 
 20.6   care services shall be a monthly rate negotiated and authorized 
 20.7   by the county agency based on an individualized service plan for 
 20.8   each resident and may not cover direct rent or food costs.  
 20.9      (1) The individualized monthly negotiated payment for 
 20.10  assisted living services as described in paragraph (g) or (h), 
 20.11  and residential care services as described in paragraph (f), 
 20.12  shall not exceed the nonfederal share in effect on July 1 of the 
 20.13  state fiscal year for which the rate limit is being calculated 
 20.14  of the greater of either the statewide or any of the geographic 
 20.15  groups' weighted average monthly nursing facility payment rate 
 20.16  of the case mix resident class to which the alternative care 
 20.17  eligible client would be assigned under Minnesota Rules, parts 
 20.18  9549.0050 to 9549.0059, less the maintenance needs allowance as 
 20.19  described in section 256B.0915, subdivision 1d, paragraph (a), 
 20.20  until the first day of the state fiscal year in which a resident 
 20.21  assessment system, under section 256B.437, of nursing home rate 
 20.22  determination is implemented.  Effective on the first day of the 
 20.23  state fiscal year in which a resident assessment system, under 
 20.24  section 256B.437, of nursing home rate determination is 
 20.25  implemented and the first day of each subsequent state fiscal 
 20.26  year, the individualized monthly negotiated payment for the 
 20.27  services described in this clause shall not exceed the limit 
 20.28  described in this clause which was in effect on the last day of 
 20.29  the previous state fiscal year and which has been adjusted by 
 20.30  the greater of any legislatively adopted home and 
 20.31  community-based services cost-of-living percentage increase or 
 20.32  any legislatively adopted statewide percent rate increase for 
 20.33  nursing facilities. 
 20.34     (2) The individualized monthly negotiated payment for 
 20.35  assisted living services described under section 144A.4605 and 
 20.36  delivered by a provider licensed by the department of health as 
 21.1   a class A home care provider or an assisted living home care 
 21.2   provider and provided in a building that is registered as a 
 21.3   housing with services establishment under chapter 144D and that 
 21.4   provides 24-hour supervision in combination with the payment for 
 21.5   other alternative care services, including case management, must 
 21.6   not exceed the limit specified in subdivision 4, paragraph (a), 
 21.7   clause (6). 
 21.8      (j) A county agency may make payment from their alternative 
 21.9   care program allocation for "other services" which include use 
 21.10  of "discretionary funds" for services that are not otherwise 
 21.11  defined in this section and direct cash payments to the client 
 21.12  for the purpose of purchasing the services.  The following 
 21.13  provisions apply to payments under this paragraph: 
 21.14     (1) a cash payment to a client under this provision cannot 
 21.15  exceed 80 percent of the monthly payment limit for that client 
 21.16  as specified in subdivision 4, paragraph (a), clause (6); 
 21.17     (2) a county may not approve any cash payment for a client 
 21.18  who meets either of the following: 
 21.19     (i) has been assessed as having a dependency in 
 21.20  orientation, unless the client has an authorized 
 21.21  representative.  An "authorized representative" means an 
 21.22  individual who is at least 18 years of age and is designated by 
 21.23  the person or the person's legal representative to act on the 
 21.24  person's behalf.  This individual may be a family member, 
 21.25  guardian, representative payee, or other individual designated 
 21.26  by the person or the person's legal representative, if any, to 
 21.27  assist in purchasing and arranging for supports; or 
 21.28     (ii) is concurrently receiving adult foster care, 
 21.29  residential care, or assisted living services; 
 21.30     (3) cash payments to a person or a person's family will be 
 21.31  provided through a monthly payment and be in the form of cash, 
 21.32  voucher, or direct county payment to a vendor.  Fees or premiums 
 21.33  assessed to the person for eligibility for health and human 
 21.34  services are not reimbursable through this service option.  
 21.35  Services and goods purchased through cash payments must be 
 21.36  identified in the person's individualized care plan and must 
 22.1   meet all of the following criteria: 
 22.2      (i) they must be over and above the normal cost of caring 
 22.3   for the person if the person did not have functional 
 22.4   limitations; 
 22.5      (ii) they must be directly attributable to the person's 
 22.6   functional limitations; 
 22.7      (iii) they must have the potential to be effective at 
 22.8   meeting the goals of the program; 
 22.9      (iv) they must be consistent with the needs identified in 
 22.10  the individualized service plan.  The service plan shall specify 
 22.11  the needs of the person and family, the form and amount of 
 22.12  payment, the items and services to be reimbursed, and the 
 22.13  arrangements for management of the individual grant; and 
 22.14     (v) the person, the person's family, or the legal 
 22.15  representative shall be provided sufficient information to 
 22.16  ensure an informed choice of alternatives.  The local agency 
 22.17  shall document this information in the person's care plan, 
 22.18  including the type and level of expenditures to be reimbursed; 
 22.19     (4) the county, lead agency under contract, or tribal 
 22.20  government under contract to administer the alternative care 
 22.21  program shall not be liable for damages, injuries, or 
 22.22  liabilities sustained through the purchase of direct supports or 
 22.23  goods by the person, the person's family, or the authorized 
 22.24  representative with funds received through the cash payments 
 22.25  under this section.  Liabilities include, but are not limited 
 22.26  to, workers' compensation, the Federal Insurance Contributions 
 22.27  Act (FICA), or the Federal Unemployment Tax Act (FUTA); 
 22.28     (5) persons receiving grants under this section shall have 
 22.29  the following responsibilities: 
 22.30     (i) spend the grant money in a manner consistent with their 
 22.31  individualized service plan with the local agency; 
 22.32     (ii) notify the local agency of any necessary changes in 
 22.33  the grant expenditures; 
 22.34     (iii) arrange and pay for supports; and 
 22.35     (iv) inform the local agency of areas where they have 
 22.36  experienced difficulty securing or maintaining supports; and 
 23.1      (6) the county shall report client outcomes, services, and 
 23.2   costs under this paragraph in a manner prescribed by the 
 23.3   commissioner. 
 23.4      (k) Upon implementation of direct cash payments to clients 
 23.5   under this section, any person determined eligible for the 
 23.6   alternative care program who chooses a cash payment approved by 
 23.7   the county agency shall receive the cash payment under this 
 23.8   section and not under section 256.476 unless the person was 
 23.9   receiving a consumer support grant under section 256.476 before 
 23.10  implementation of direct cash payments under this section. 
 23.11     Sec. 7.  Minnesota Statutes 2001 Supplement, section 
 23.12  256B.0915, subdivision 3, is amended to read: 
 23.13     Subd. 3.  [LIMITS OF CASES, RATES, PAYMENTS, AND 
 23.14  FORECASTING.] (a) The number of medical assistance waiver 
 23.15  recipients that a county may serve must be allocated according 
 23.16  to the number of medical assistance waiver cases open on July 1 
 23.17  of each fiscal year.  Additional recipients may be served with 
 23.18  the approval of the commissioner. 
 23.19     (b) The monthly limit for the cost of waivered services to 
 23.20  an individual elderly waiver client shall be the weighted 
 23.21  average monthly nursing facility rate of the case mix resident 
 23.22  class to which the elderly waiver client would be assigned under 
 23.23  Minnesota Rules, parts 9549.0050 to 9549.0059, less the 
 23.24  recipient's maintenance needs allowance as described in 
 23.25  subdivision 1d, paragraph (a), until the first day of the state 
 23.26  fiscal year in which the resident assessment system as described 
 23.27  in section 256B.437 for nursing home rate determination is 
 23.28  implemented.  Effective on the first day of the state fiscal 
 23.29  year in which the resident assessment system as described in 
 23.30  section 256B.437 for nursing home rate determination is 
 23.31  implemented and the first day of each subsequent state fiscal 
 23.32  year, the monthly limit for the cost of waivered services to an 
 23.33  individual elderly waiver client shall be the rate of the case 
 23.34  mix resident class to which the waiver client would be assigned 
 23.35  under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect 
 23.36  on the last day of the previous state fiscal year, adjusted by 
 24.1   the greater of any legislatively adopted home and 
 24.2   community-based services cost-of-living percentage increase or 
 24.3   any legislatively adopted statewide percent rate increase for 
 24.4   nursing facilities. 
 24.5      (c) If extended medical supplies and equipment or 
 24.6   environmental modifications are or will be purchased for an 
 24.7   elderly waiver client, the costs may be prorated for up to 12 
 24.8   consecutive months beginning with the month of purchase.  If the 
 24.9   monthly cost of a recipient's waivered services exceeds the 
 24.10  monthly limit established in paragraph (b), the annual cost of 
 24.11  all waivered services shall be determined.  In this event, the 
 24.12  annual cost of all waivered services shall not exceed 12 times 
 24.13  the monthly limit of waivered services as described in paragraph 
 24.14  (b).  
 24.15     (d) For a person who is a nursing facility resident at the 
 24.16  time of requesting a determination of eligibility for elderly 
 24.17  waivered services, a monthly conversion limit for the cost of 
 24.18  elderly waivered services may be requested.  The monthly 
 24.19  conversion limit for the cost of elderly waiver services shall 
 24.20  be the resident class assigned under Minnesota Rules, parts 
 24.21  9549.0050 to 9549.0059, for that resident in the nursing 
 24.22  facility where the resident currently resides until July 1 of 
 24.23  the state fiscal year in which the resident assessment system as 
 24.24  described in section 256B.437 for nursing home rate 
 24.25  determination is implemented.  Effective on July 1 of the state 
 24.26  fiscal year in which the resident assessment system as described 
 24.27  in section 256B.437 for nursing home rate determination is 
 24.28  implemented, the monthly conversion limit for the cost of 
 24.29  elderly waiver services shall be the per diem nursing facility 
 24.30  rate as determined by the resident assessment system as 
 24.31  described in section 256B.437 for that resident in the nursing 
 24.32  facility where the resident currently resides multiplied by 365 
 24.33  and divided by 12, less the recipient's maintenance needs 
 24.34  allowance as described in subdivision 1d.  The initially 
 24.35  approved conversion rate may be adjusted by the greater of any 
 24.36  subsequent legislatively adopted home and community-based 
 25.1   services cost-of-living percentage increase or any subsequent 
 25.2   legislatively adopted statewide percentage rate increase for 
 25.3   nursing facilities.  The limit under this clause only applies to 
 25.4   persons discharged from a nursing facility after a minimum 
 25.5   30-day stay and found eligible for waivered services on or after 
 25.6   July 1, 1997.  The following costs must be included in 
 25.7   determining the total monthly costs for the waiver client: 
 25.8      (1) cost of all waivered services, including extended 
 25.9   medical supplies and equipment and environmental modifications; 
 25.10  and 
 25.11     (2) cost of skilled nursing, home health aide, and personal 
 25.12  care services reimbursable by medical assistance.  
 25.13     (e) Medical assistance funding for skilled nursing 
 25.14  services, private duty nursing, home health aide, and personal 
 25.15  care services for waiver recipients must be approved by the case 
 25.16  manager and included in the individual care plan. 
 25.17     (f) A county is not required to contract with a provider of 
 25.18  supplies and equipment if the monthly cost of the supplies and 
 25.19  equipment is less than $250.  
 25.20     (g) The adult foster care rate shall be considered a 
 25.21  difficulty of care payment and shall not include room and 
 25.22  board.  The adult foster care service rate shall be negotiated 
 25.23  between the county agency and the foster care provider.  The 
 25.24  elderly waiver payment for the foster care service in 
 25.25  combination with the payment for all other elderly waiver 
 25.26  services, including case management, must not exceed the limit 
 25.27  specified in paragraph (b). 
 25.28     (h) Payment for assisted living service shall be a monthly 
 25.29  rate negotiated and authorized by the county agency based on an 
 25.30  individualized service plan for each resident and may not cover 
 25.31  direct rent or food costs. 
 25.32     (1) The individualized monthly negotiated payment for 
 25.33  assisted living services as described in section 256B.0913, 
 25.34  subdivision 5, paragraph (g) or (h), and residential care 
 25.35  services as described in section 256B.0913, subdivision 5, 
 25.36  paragraph (f), shall not exceed the nonfederal share, in effect 
 26.1   on July 1 of the state fiscal year for which the rate limit is 
 26.2   being calculated, of the greater of either the statewide or any 
 26.3   of the geographic groups' weighted average monthly nursing 
 26.4   facility rate of the case mix resident class to which the 
 26.5   elderly waiver eligible client would be assigned under Minnesota 
 26.6   Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 
 26.7   allowance as described in subdivision 1d, paragraph (a), until 
 26.8   the July 1 of the state fiscal year in which the resident 
 26.9   assessment system as described in section 256B.437 for nursing 
 26.10  home rate determination is implemented.  Effective on July 1 of 
 26.11  the state fiscal year in which the resident assessment system as 
 26.12  described in section 256B.437 for nursing home rate 
 26.13  determination is implemented and July 1 of each subsequent state 
 26.14  fiscal year, the individualized monthly negotiated payment for 
 26.15  the services described in this clause shall not exceed the limit 
 26.16  described in this clause which was in effect on June 30 of the 
 26.17  previous state fiscal year and which has been adjusted by the 
 26.18  greater of any legislatively adopted home and community-based 
 26.19  services cost-of-living percentage increase or any legislatively 
 26.20  adopted statewide percent rate increase for nursing facilities. 
 26.21     (2) The individualized monthly negotiated payment for 
 26.22  assisted living services described in section 144A.4605 and 
 26.23  delivered by a provider licensed by the department of health as 
 26.24  a class A home care provider or an assisted living home care 
 26.25  provider and provided in a building that is registered as a 
 26.26  housing with services establishment under chapter 144D and that 
 26.27  provides 24-hour supervision in combination with the payment for 
 26.28  other elderly waiver services, including case management, must 
 26.29  not exceed the limit specified in paragraph (b). 
 26.30     (i) The county shall negotiate individual service rates 
 26.31  with vendors and may authorize payment for actual costs up to 
 26.32  the county's current approved rate.  Persons or agencies must be 
 26.33  employed by or under a contract with the county agency or the 
 26.34  public health nursing agency of the local board of health in 
 26.35  order to receive funding under the elderly waiver program, 
 26.36  except as a provider of supplies and equipment when the monthly 
 27.1   cost of the supplies and equipment is less than $250.  
 27.2      (j) Reimbursement for the medical assistance recipients 
 27.3   under the approved waiver shall be made from the medical 
 27.4   assistance account through the invoice processing procedures of 
 27.5   the department's Medicaid Management Information System (MMIS), 
 27.6   only with the approval of the client's case manager.  The budget 
 27.7   for the state share of the Medicaid expenditures shall be 
 27.8   forecasted with the medical assistance budget, and shall be 
 27.9   consistent with the approved waiver.  
 27.10     (k) To improve access to community services and eliminate 
 27.11  payment disparities between the alternative care program and the 
 27.12  elderly waiver, the commissioner shall establish statewide 
 27.13  maximum service rate limits and eliminate county-specific 
 27.14  service rate limits. 
 27.15     (1) Effective July 1, 2001, for service rate limits, except 
 27.16  those described or defined in paragraphs (g) and (h), the rate 
 27.17  limit for each service shall be the greater of the alternative 
 27.18  care statewide maximum rate or the elderly waiver statewide 
 27.19  maximum rate. 
 27.20     (2) Counties may negotiate individual service rates with 
 27.21  vendors for actual costs up to the statewide maximum service 
 27.22  rate limit. 
 27.23     (l) Beginning July 1, 1991, the state shall reimburse 
 27.24  counties according to the payment schedule in section 256.025 
 27.25  for the county share of costs incurred under this subdivision on 
 27.26  or after January 1, 1991, for individuals who are receiving 
 27.27  medical assistance. 
 27.28     Sec. 8.  Minnesota Statutes 2001 Supplement, section 
 27.29  256B.0924, subdivision 6, is amended to read: 
 27.30     Subd. 6.  [PAYMENT FOR TARGETED CASE MANAGEMENT.] (a) 
 27.31  Medical assistance and MinnesotaCare payment for targeted case 
 27.32  management shall be made on a monthly basis.  In order to 
 27.33  receive payment for an eligible adult, the provider must 
 27.34  document at least one contact per month and not more than two 
 27.35  consecutive months without a face-to-face contact with the adult 
 27.36  or the adult's legal representative, family, primary caregiver, 
 28.1   or other relevant persons identified as necessary to the 
 28.2   development or implementation of the goals of the personal 
 28.3   service plan. 
 28.4      (b) Payment for targeted case management provided by county 
 28.5   staff under this subdivision shall be based on the monthly rate 
 28.6   methodology under section 256B.094, subdivision 6, paragraph 
 28.7   (b), calculated as one combined average rate together with adult 
 28.8   mental health case management under section 256B.0625, 
 28.9   subdivision 20, except for calendar year 2002.  In calendar year 
 28.10  2002, the rate for case management under this section shall be 
 28.11  the same as the rate for adult mental health case management in 
 28.12  effect as of December 31, 2001.  Billing and payment must 
 28.13  identify the recipient's primary population group to allow 
 28.14  tracking of revenues. 
 28.15     (c) Payment for targeted case management provided by 
 28.16  county-contracted vendors shall be based on a monthly rate 
 28.17  negotiated by the host county.  The negotiated rate must not 
 28.18  exceed the rate charged by the vendor for the same service to 
 28.19  other payers.  If the service is provided by a team of 
 28.20  contracted vendors, the county may negotiate a team rate with a 
 28.21  vendor who is a member of the team.  The team shall determine 
 28.22  how to distribute the rate among its members.  No reimbursement 
 28.23  received by contracted vendors shall be returned to the county, 
 28.24  except to reimburse the county for advance funding provided by 
 28.25  the county to the vendor. 
 28.26     (d) If the service is provided by a team that includes 
 28.27  contracted vendors and county staff, the costs for county staff 
 28.28  participation on the team shall be included in the rate for 
 28.29  county-provided services.  In this case, the contracted vendor 
 28.30  and the county may each receive separate payment for services 
 28.31  provided by each entity in the same month.  In order to prevent 
 28.32  duplication of services, the county must document, in the 
 28.33  recipient's file, the need for team targeted case management and 
 28.34  a description of the different roles of the team members. 
 28.35     (e) Notwithstanding section 256B.19, subdivision 1, the 
 28.36  nonfederal share of costs for targeted case management shall be 
 29.1   provided by the recipient's county of responsibility, as defined 
 29.2   in sections 256G.01 to 256G.12, from sources other than federal 
 29.3   funds or funds used to match other federal funds. 
 29.4      (f) The commissioner may suspend, reduce, or terminate 
 29.5   reimbursement to a provider that does not meet the reporting or 
 29.6   other requirements of this section.  The county of 
 29.7   responsibility, as defined in sections 256G.01 to 256G.12, is 
 29.8   responsible for any federal disallowances.  The county may share 
 29.9   this responsibility with its contracted vendors. 
 29.10     (g) The commissioner shall set aside five percent of the 
 29.11  federal funds received under this section for use in reimbursing 
 29.12  the state for costs of developing and implementing this section. 
 29.13     (h) Notwithstanding section 256.025, subdivision 2, 
 29.14  payments to counties for targeted case management expenditures 
 29.15  under this section shall only be made from federal earnings from 
 29.16  services provided under this section.  Payments to contracted 
 29.17  vendors shall include both the federal earnings and the county 
 29.18  share. 
 29.19     (i) Notwithstanding section 256B.041, county payments for 
 29.20  the cost of case management services provided by county staff 
 29.21  shall not be made to the state treasurer.  For the purposes of 
 29.22  targeted case management services provided by county staff under 
 29.23  this section, the centralized disbursement of payments to 
 29.24  counties under section 256B.041 consists only of federal 
 29.25  earnings from services provided under this section. 
 29.26     (j) If the recipient is a resident of a nursing facility, 
 29.27  intermediate care facility, or hospital, and the recipient's 
 29.28  institutional care is paid by medical assistance, payment for 
 29.29  targeted case management services under this subdivision is 
 29.30  limited to the last 180 days of the recipient's residency in 
 29.31  that facility and may not exceed more than six months in a 
 29.32  calendar year. 
 29.33     (k) Payment for targeted case management services under 
 29.34  this subdivision shall not duplicate payments made under other 
 29.35  program authorities for the same purpose. 
 29.36     (l) Any growth in targeted case management services and 
 30.1   cost increases under this section shall be the responsibility of 
 30.2   the counties. 
 30.3      Sec. 9.  Minnesota Statutes 2001 Supplement, section 
 30.4   256B.0951, subdivision 7, is amended to read: 
 30.5      Subd. 7.  [WAIVER OF RULES.] If a federal waiver is 
 30.6   approved under subdivision 8, the commissioner of health may 
 30.7   exempt residents of intermediate care facilities for persons 
 30.8   with mental retardation (ICFs/MR) who participate in the 
 30.9   three-year alternative quality assurance pilot project 
 30.10  established in section 256B.095 from the requirements of 
 30.11  Minnesota Rules, chapter 4665, upon approval by the federal 
 30.12  government of a waiver of federal certification requirements for 
 30.13  ICFs/MR.  
 30.14     Sec. 10.  Minnesota Statutes 2001 Supplement, section 
 30.15  256B.0951, subdivision 8, is amended to read: 
 30.16     Subd. 8.  [FEDERAL WAIVER.] The commissioner of human 
 30.17  services shall seek federal authority to waive provisions of 
 30.18  intermediate care facilities for persons with mental retardation 
 30.19  (ICFs/MR) regulations to enable the demonstration and evaluation 
 30.20  of the alternative quality assurance system for ICFs/MR under 
 30.21  the project.  The commissioner of human services shall apply for 
 30.22  any necessary waivers as soon as practicable. a federal waiver 
 30.23  to allow intermediate care facilities for persons with mental 
 30.24  retardation (ICFs/MR) in Region 10 of Minnesota to participate 
 30.25  in the alternative licensing system.  If it is necessary for 
 30.26  purposes of participation in this alternative licensing system 
 30.27  for a facility to be decertified as an ICF/MR facility according 
 30.28  to the terms of the federal waiver, when the facility seeks 
 30.29  recertification under the provisions of ICF/MR regulations at 
 30.30  the end of the demonstration project, it will not be considered 
 30.31  a new ICF/MR as defined under section 252.291 provided the 
 30.32  licensed capacity of the facility did not increase during its 
 30.33  participation in the alternative licensing system.  The 
 30.34  provisions of sections 252.82, 252.292, and 256B.5011 to 
 30.35  256B.5015 will remain applicable for counties in Region 10 of 
 30.36  Minnesota and the ICFs/MR located within those counties 
 31.1   notwithstanding a county's participation in the alternative 
 31.2   licensing system. 
 31.3      Sec. 11.  Minnesota Statutes 2001 Supplement, section 
 31.4   256B.437, subdivision 6, is amended to read: 
 31.5      Subd. 6.  [PLANNED CLOSURE RATE ADJUSTMENT.] (a) The 
 31.6   commissioner of human services shall calculate the amount of the 
 31.7   planned closure rate adjustment available under subdivision 3, 
 31.8   paragraph (b), for up to 5,140 beds according to clauses (1) to 
 31.9   (4): 
 31.10     (1) the amount available is the net reduction of nursing 
 31.11  facility beds multiplied by $2,080; 
 31.12     (2) the total number of beds in the nursing facility or 
 31.13  facilities receiving the planned closure rate adjustment must be 
 31.14  identified; 
 31.15     (3) capacity days are determined by multiplying the number 
 31.16  determined under clause (2) by 365; and 
 31.17     (4) the planned closure rate adjustment is the amount 
 31.18  available in clause (1), divided by capacity days determined 
 31.19  under clause (3). 
 31.20     (b) A planned closure rate adjustment under this section is 
 31.21  effective on the first day of the month following completion of 
 31.22  closure of the facility designated for closure in the 
 31.23  application and becomes part of the nursing facility's total 
 31.24  operating payment rate. 
 31.25     (c) Applicants may use the planned closure rate adjustment 
 31.26  to allow for a property payment for a new nursing facility or an 
 31.27  addition to an existing nursing facility or as an operating 
 31.28  payment rate adjustment.  Applications approved under this 
 31.29  subdivision are exempt from other requirements for moratorium 
 31.30  exceptions under section 144A.073, subdivisions 2 and 3. 
 31.31     (d) Upon the request of a closing facility, the 
 31.32  commissioner must allow the facility a closure rate adjustment 
 31.33  as provided under section 144A.161, subdivision 10. 
 31.34     (e) A facility that has received a planned closure rate 
 31.35  adjustment may reassign it to another facility that is under the 
 31.36  same ownership at any time within three years of its effective 
 32.1   date.  The amount of the adjustment shall be computed according 
 32.2   to paragraph (a).