1.1 	A bill for an act
1.2 	relating to human services; authorizing a medical assistance self-directed 
1.3 	supports option; expanding eligibility for Minnesota supplemental aid shelter 
1.4 	needy payments; authorizing licensure of nonresidential programs for youth with 
1.5 	disabilities; appropriating money; amending Minnesota Statutes 2006, sections 
1.6 	256B.0625, by adding a subdivision; 256D.44, subdivision 5; proposing coding 
1.7 	for new law in Minnesota Statutes, chapter 256B.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2006, section 256B.0625, is amended by adding a 
1.10 	subdivision to read:
1.11 		Subd. 49.Self-directed personal services. Upon federal approval, medical 
1.12 	assistance covers the self-directed supports option as defined under section 256B.0657 and 
1.13 	section 6087 of the Federal Deficit Reduction Act of 2005, Public Law 109-171.

1.14 	EFFECTIVE DATE. This section is effective upon federal approval of the state 
1.15 	Medicaid plan amendment. The commissioner of human services shall inform the Office 
1.16 	of the Revisor of Statutes when approval is obtained.

1.17 	Sec. 2. [256B.0657] SELF-DIRECTED SUPPORTS OPTION.
1.18 		Subdivision 1.Definition. "Self-directed supports option" means personal 
1.19 	assistance, supports, items, and related services purchased under an approved budget 
1.20 	plan and budget by a recipient.
1.21 		Subd. 2.Eligibility. (a) The self-directed supports option is available to a person 
1.22 	who:
1.23 	(1) is a recipient of medical assistance as determined under sections 256B.055, 
1.24 	256B.056, and 256B.057, subdivision 9;
2.1 	(2) is eligible for personal care assistant services under section 256B.0655;
2.2 	(3) lives in the person's own apartment or home, which is not owned, operated, or 
2.3 	controlled by a provider of services not related by blood or marriage;
2.4 	(4) has the ability to hire, fire, supervise, establish staff compensation for, and 
2.5 	manage the individuals providing services, and to choose and obtain items, related 
2.6 	services, and supports as described in the participant's plan. If the recipient is not able to 
2.7 	carry out these functions but has a legal guardian or parent to carry them out, the guardian 
2.8 	or parent may fulfill these functions on behalf of the recipient; and
2.9 	(5) has not been excluded or disenrolled by the commissioner.
2.10 	(b) The commissioner may disenroll or exclude recipients, including guardians and 
2.11 	parents, under the following circumstances:
2.12 	(1) recipients who have been restricted by the Primary Care Utilization Review 
2.13 	Committee may be excluded for a specified time period; and 
2.14 	(2) recipients who exit the self-directed supports option during the recipient's 
2.15 	service plan year shall not access the self-directed supports option for the remainder 
2.16 	of that service plan year.
2.17 		Subd. 3.Eligibility for other services. Selection of the self-directed supports 
2.18 	option by a recipient shall not restrict access to other medically necessary care and 
2.19 	services furnished under the state plan medical assistance benefit, including home care 
2.20 	targeted case management, except that a person receiving home and community-based 
2.21 	waiver services, a family support grant or a consumer support grant is not eligible for 
2.22 	funding under the self-directed supports option.
2.23 		Subd. 4.Assessment requirements. (a) The self-directed supports option 
2.24 	assessment must meet the following requirements:
2.25 	(1) it shall be conducted by the county public health nurse or a certified public 
2.26 	health nurse under contract with the county;
2.27 	(2) it shall be conducted face-to-face in the recipient's home initially, and at least 
2.28 	annually thereafter; when there is a significant change in the recipient's condition; and 
2.29 	when there is a change in the need for personal care assistant services. A recipient who is 
2.30 	residing in a facility may be assessed for the self-directed support option for the purpose 
2.31 	of returning to the community using this option; and 
2.32 	(3) it shall be completed using the format established by the commissioner.
2.33 	(b) The results of the assessment and recommendations shall be communicated to 
2.34 	the commissioner and the recipient by the county public health nurse or certified public 
2.35 	health nurse under contract with the county.
3.1 		Subd. 5.Self-directed supports option plan requirements. (a) The plan for the 
3.2 	self-directed supports option must meet the following requirements:
3.3 	(1) the plan must be completed using a person-centered process that:
3.4 	(i) builds upon the recipient's capacity to engage in activities that promote 
3.5 	community life;
3.6 	(ii) respects the recipient's preferences, choices, and abilities;
3.7 	(iii) involves families, friends, and professionals in the planning or delivery of 
3.8 	services or supports as desired or required by the recipient; and 
3.9 	(iv) addresses the need for personal care assistant services identified in the recipient's 
3.10 	self-directed supports option assessment;
3.11 	(2) the plan shall be developed by the recipient or by the guardian of an adult 
3.12 	recipient or by a parent or guardian of a minor child, with the assistance of an enrolled 
3.13 	medical assistance home care targeted case manager provider who meets the requirements 
3.14 	established for using a person-centered planning process and shall be reviewed at least 
3.15 	annually upon reassessment or when there is a significant change in the recipient's 
3.16 	condition; and 
3.17 	(3) the plan must include the total budget amount available divided into monthly 
3.18 	amounts that cover the number of months of personal care assistant services authorization 
3.19 	included in the budget. The amount used each month may vary, but additional funds shall 
3.20 	not be provided above the annual personal care assistant services authorized amount 
3.21 	unless a change in condition is documented.
3.22 	(b) The commissioner shall:
3.23 	(1) establish the format and criteria for the plan as well as the requirements for 
3.24 	providers who assist with plan development;
3.25 	(2) review the assessment and plan and, within 30 days after receiving the 
3.26 	assessment and plan, make a decision on approval of the plan;
3.27 	(3) notify the recipient, parent, or guardian of approval or denial of the plan and 
3.28 	provide notice of the right to appeal under section 256.045; and 
3.29 	(4) provide a copy of the plan to the fiscal support entity selected by the recipient.
3.30 		Subd. 6.Services covered. (a) Services covered under the self-directed supports 
3.31 	option include:
3.32 	(1) personal care assistant services under section 256B.0655; and 
3.33 	(2) items, related services, and supports, including assistive technology, that increase 
3.34 	independence or substitute for human assistance to the extent expenditures would 
3.35 	otherwise be used for human assistance.
4.1 	(b) Items, supports, and related services purchased under this option shall not be 
4.2 	considered home care services for the purposes of section 144A.43.
4.3 		Subd. 7.Noncovered services. Services or supports that are not eligible for 
4.4 	payment under the self-directed supports option include:
4.5 	(1) services, goods, or supports that do not benefit the recipient;
4.6 	(2) any fees incurred by the recipient, such as Minnesota health care program fees 
4.7 	and co-pays, legal fees, or costs related to advocate agencies;
4.8 	(3) insurance, except for insurance costs related to employee coverage or fiscal 
4.9 	support entity payments;
4.10 	(4) room and board and personal items that are not related to the disability, except 
4.11 	that medically prescribed specialized diet items may be covered if they reduce the need for 
4.12 	human assistance;
4.13 	(5) home modifications that add square footage;
4.14 	(6) home modifications for a residence other than the primary residence of the 
4.15 	recipient, or in the event of a minor with parents not living together, the primary residences 
4.16 	of the parents;
4.17 	(7) expenses for travel, lodging, or meals related to training the recipient, the parent 
4.18 	or guardian of an adult recipient, or the parent or guardian of a minor child, or paid or 
4.19 	unpaid caregivers that exceed $500 in a 12-month period;
4.20 	(8) experimental treatment;
4.21 	(9) any service or item covered by other medical assistance state plan services, 
4.22 	including prescription and over-the-counter medications, compounds, and solutions and 
4.23 	related fees, including premiums and co-payments;
4.24 	(10) membership dues or costs, except when the service is necessary and appropriate 
4.25 	to treat a physical condition or to improve or maintain the recipient's physical condition. 
4.26 	The condition must be identified in the recipient's plan of care and monitored by a 
4.27 	Minnesota health care program enrolled physician;
4.28 	(11) vacation expenses other than the cost of direct services;
4.29 	(12) vehicle maintenance or modifications not related to the disability;
4.30 	(13) tickets and related costs to attend sporting or other recreational events; and
4.31 	(14) costs related to Internet access, except when necessary for operation of assistive 
4.32 	technology, to increase independence, or to substitute for human assistance.
4.33 		Subd. 8.Self-directed budget requirements. The budget for the provision of the 
4.34 	self-directed service option shall be equal to the greater of either:
4.35 	(1) the annual amount of personal care assistant services under section 256B.0655 
4.36 	that the recipient has used in the most recent 12-month period; or 
5.1 	(2) the amount determined using the consumer support grant methodology under 
5.2 	section 256.476, subdivision 11, except that the budget amount shall include the federal 
5.3 	and nonfederal share of the average service costs.
5.4 		Subd. 9.Quality assurance and risk management. (a) The commissioner 
5.5 	shall establish quality assurance and risk management measures for use in developing 
5.6 	and implementing self-directed plans and budgets that (1) recognize the roles and 
5.7 	responsibilities involved in obtaining services in a self-directed manner, and (2) assure 
5.8 	the appropriateness of such plans and budgets based upon a recipient's resources and 
5.9 	capabilities. These measures must include (i) background studies, and (ii) backup and 
5.10 	emergency plans, including disaster planning.
5.11 	(b) The commissioner shall provide ongoing technical assistance and resource and 
5.12 	educational materials for families and recipients selecting the self-directed option.
5.13 	(c) Performance assessments measures, such as of a recipient's satisfaction with the 
5.14 	services and supports, and ongoing monitoring of health and well-being shall be identified 
5.15 	in consultation with the stakeholder group.
5.16 		Subd. 10.Fiscal support entity. (a) Each recipient shall choose a fiscal support 
5.17 	entity provider certified by the commissioner to make payments for services, items, 
5.18 	supports, and administrative costs related to managing a self-directed service plan 
5.19 	authorized for payment in the approved plan and budget. Recipients shall also choose 
5.20 	the payroll, agency with choice, or the fiscal conduit model of financial and service 
5.21 	management.
5.22 	(b) The fiscal support entity:
5.23 	(1) may not limit or restrict the recipient's choice of service or support providers, 
5.24 	including use of the payroll, agency with choice, or fiscal conduit model of financial 
5.25 	and service management; 
5.26 	(2) must have a written agreement with the recipient or the recipient's representative 
5.27 	that identifies the duties and responsibilities to be performed and the specific related 
5.28 	charges; 
5.29 	(3) must provide the recipient and the home care targeted case manager with a 
5.30 	monthly written summary of the self-directed supports option services that were billed, 
5.31 	including charges from the fiscal support entity;
5.32 	(4) must be knowledgeable of and comply with Internal Revenue Service 
5.33 	requirements necessary to process employer and employee deductions, provide appropriate 
5.34 	and timely submission of employer tax liabilities, and maintain documentation to support 
5.35 	medical assistance claims; 
6.1 	(5) must have current and adequate liability insurance and bonding and sufficient 
6.2 	cash flow and have on staff or under contract a certified public accountant or an individual 
6.3 	with a baccalaureate degree in accounting; and 
6.4 	(6) must maintain records to track all self-directed supports option services 
6.5 	expenditures, including time records of persons paid to provide supports and receipts for 
6.6 	any goods purchased. The records must be maintained for a minimum of five years from 
6.7 	the claim date and be available for audit or review upon request. Claims submitted by 
6.8 	the fiscal support entity must correspond with services, amounts, and time periods as 
6.9 	authorized in the recipient's self-directed supports option plan.
6.10 	(c) The commissioner shall have authority to:
6.11 	(1) set or negotiate rates with fiscal support entities;
6.12 	(2) limit the number of fiscal support entities;
6.13 	(3) identify a process to certify and recertify fiscal support entities and assure fiscal 
6.14 	support entities are available to recipients throughout the state; and 
6.15 	(4) establish a uniform format and protocol to be used by eligible fiscal support 
6.16 	entities.
6.17 		Subd. 11.Stakeholder consultation. The commissioner shall consult with a 
6.18 	statewide consumer-directed services stakeholder group, including representatives of 
6.19 	all types of consumer-directed service users, advocacy organizations, counties, and 
6.20 	consumer-directed service providers. The commissioner shall seek recommendations 
6.21 	from this stakeholder group in developing:
6.22 	(1) the self-directed plan format;
6.23 	(2) requirements and guidelines for the person-centered plan assessment and 
6.24 	planning process;
6.25 	(3) implementation of the option and the quality assurance and risk management 
6.26 	techniques; and 
6.27 	(4) standards and requirements, including rates for the personal support plan 
6.28 	development provider and the fiscal support entity; policies; training; and implementation. 
6.29 	The stakeholder group shall provide recommendations on the repeal of the personal care 
6.30 	assistant choice option, transition issues, and whether the consumer support grant program 
6.31 	under section 256.476 should be modified. The stakeholder group shall meet at least 
6.32 	three times each year to provide advice on policy, implementation, and other aspects of 
6.33 	consumer and self-directed services.

6.34 	EFFECTIVE DATE. Subdivisions 1 to 10 are effective upon federal approval of 
6.35 	the state Medicaid plan amendment. The commissioner of human services shall inform 
7.1 	the Office of the Revisor of Statutes when federal approval is obtained. Subdivision 11 
7.2 	is effective July 1, 2007.

7.3 	Sec. 3. Minnesota Statutes 2006, section 256D.44, subdivision 5, is amended to read:
7.4 		Subd. 5.Special needs. In addition to the state standards of assistance established in 
7.5 	subdivisions 1 to 4, payments are allowed for the following special needs of recipients of 
7.6 	Minnesota supplemental aid who are not residents of a nursing home, a regional treatment 
7.7 	center, or a group residential housing facility.
7.8 	(a) The county agency shall pay a monthly allowance for medically prescribed 
7.9 	diets if the cost of those additional dietary needs cannot be met through some other 
7.10 	maintenance benefit. The need for special diets or dietary items must be prescribed by 
7.11 	a licensed physician. Costs for special diets shall be determined as percentages of the 
7.12 	allotment for a one-person household under the thrifty food plan as defined by the United 
7.13 	States Department of Agriculture. The types of diets and the percentages of the thrifty 
7.14 	food plan that are covered are as follows:
7.15 	(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
7.16 	(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent 
7.17 	of thrifty food plan;
7.18 	(3) controlled protein diet, less than 40 grams and requires special products, 125 
7.19 	percent of thrifty food plan;
7.20 	(4) low cholesterol diet, 25 percent of thrifty food plan;
7.21 	(5) high residue diet, 20 percent of thrifty food plan;
7.22 	(6) pregnancy and lactation diet, 35 percent of thrifty food plan;
7.23 	(7) gluten-free diet, 25 percent of thrifty food plan;
7.24 	(8) lactose-free diet, 25 percent of thrifty food plan;
7.25 	(9) antidumping diet, 15 percent of thrifty food plan;
7.26 	(10) hypoglycemic diet, 15 percent of thrifty food plan; or
7.27 	(11) ketogenic diet, 25 percent of thrifty food plan.
7.28 	(b) Payment for nonrecurring special needs must be allowed for necessary home 
7.29 	repairs or necessary repairs or replacement of household furniture and appliances using 
7.30 	the payment standard of the AFDC program in effect on July 16, 1996, for these expenses, 
7.31 	as long as other funding sources are not available.
7.32 	(c) A fee for guardian or conservator service is allowed at a reasonable rate 
7.33 	negotiated by the county or approved by the court. This rate shall not exceed five percent 
7.34 	of the assistance unit's gross monthly income up to a maximum of $100 per month. If the 
7.35 	guardian or conservator is a member of the county agency staff, no fee is allowed.
8.1 	(d) The county agency shall continue to pay a monthly allowance of $68 for 
8.2 	restaurant meals for a person who was receiving a restaurant meal allowance on June 1, 
8.3 	1990, and who eats two or more meals in a restaurant daily. The allowance must continue 
8.4 	until the person has not received Minnesota supplemental aid for one full calendar month 
8.5 	or until the person's living arrangement changes and the person no longer meets the criteria 
8.6 	for the restaurant meal allowance, whichever occurs first.
8.7 	(e) A fee of ten percent of the recipient's gross income or $25, whichever is less, 
8.8 	is allowed for representative payee services provided by an agency that meets the 
8.9 	requirements under SSI regulations to charge a fee for representative payee services. This 
8.10 	special need is available to all recipients of Minnesota supplemental aid regardless of 
8.11 	their living arrangement.
8.12 	(f) Notwithstanding the language in this subdivision, an amount equal to the 
8.13 	maximum allotment authorized by the federal Food Stamp Program for a single individual 
8.14 	which is in effect on the first day of January July of the previous each year will be added 
8.15 	to the standards of assistance established in subdivisions 1 to 4 for individuals adults
8.16 	under the age of 65 who qualify as shelter needy and are:
8.17 	(1)  relocating from an institution, or an adult mental health residential treatment 
8.18 	program under section 256B.0622, and who are shelter needy;
8.19 	(2) self-directed supports option participants defined under section 256B.0657; or 
8.20 	(3) home and community-based waiver recipients living in their own rented, leased, 
8.21 	or owned apartment or home not owned, operated, or controlled by a provider of service 
8.22 	not related by blood or marriage.
8.23 	Notwithstanding subdivision 3, paragraph (c), an individual eligible for the shelter needy 
8.24 	benefit under this paragraph is considered a household of one. An eligible individual who 
8.25 	receives this benefit prior to age 65 may continue to receive the benefit after the age of 65.
8.26 	(g) (1) Persons eligible for shelter needy funding under paragraph (f), who are not 
8.27 	receiving medical assistance home and community-based waiver services, are eligible for 
8.28 	a state-funded transitional supports allowance under section 256B.49, subdivision 16, 
8.29 	paragraph (e), to establish their own residence not owned, operated, or controlled by a 
8.30 	provider of service not related by blood or marriage.
8.31 	(2) "Shelter needy" means that the assistance unit incurs monthly shelter costs that 
8.32 	exceed 40 percent of the assistance unit's gross income before the application of this 
8.33 	special needs standard. "Gross income" for the purposes of this section is the applicant's or 
8.34 	recipient's income as defined in section 256D.35, subdivision 10, or the standard specified 
8.35 	in subdivision 3, whichever is greater. A recipient of a federal or state housing subsidy, 
9.1 	that limits shelter costs to a percentage of gross income, shall not be considered shelter 
9.2 	needy for purposes of this paragraph.

9.3 	Sec. 4. LICENSURE; SERVICES FOR YOUTH WITH DISABILITIES.
 9.4 	(a) Notwithstanding the requirements of Minnesota Statutes, chapter 245A, upon the 
9.5 	recommendation of a county agency, the commissioner of human services shall grant a 
9.6 	license with any necessary variances to a nonresidential program for youth that provides 
9.7 	services to youth with disabilities under age 21 during nonschool hours established 
9.8 	to ensure health and safety, prevent out-of-home placement, and increase community 
9.9 	inclusion of youth with disabilities. The nonresidential youth program is subject to the 
9.10 	conditions of any variances granted and with consumer rights under Minnesota Statutes, 
9.11 	section 245B.04, consumer protection standards under Minnesota Statutes, section 
9.12 	245B.05, service standards under Minnesota Statutes, section 245B.06, management 
9.13 	standards under Minnesota Statutes, section 245B.07, and fire marshal inspections under 
9.14 	Minnesota Statutes, section 245A.151, until the commissioner develops other licensure 
9.15 	requirements for this type of program.
9.16 	(b) By February 1, 2008, the commissioner shall recommend amendments to 
9.17 	licensure requirements in Minnesota Statutes, chapter 245A, to allow licensure of 
9.18 	appropriate services for school-age youth with disabilities under age 21 who need 
9.19 	supervision and services to develop skills necessary to maintain personal safety and 
9.20 	increase their independence, productivity, and participation in their communities during 
9.21 	nonschool hours. As part of developing the recommendations, the commissioner shall 
9.22 	survey county agencies to determine how the needs of youth with disabilities under age 21 
9.23 	who require supervision and support services are being met and the funding sources used. 
9.24 	The recommendations must be provided to the house and senate chairs of the committees 
9.25 	with jurisdiction over licensing of programs for youth with disabilities.

9.26 	Sec. 5. APPROPRIATIONS.
 9.27 	(a) $....... is appropriated from the general fund to the commissioner of human 
9.28 	services to provide the nonfederal Medicaid match for the assessment, self-directed 
9.29 	supports option plan development, and other administrative costs related to implementing 
9.30 	and managing the self-directed supports option, including quality assurance measures. 
9.31 	Federal Medicaid match obtained for administrative activities for this option must be 
9.32 	dedicated to the commissioner for this purpose.
9.33 	(b) $....... is appropriated from the general fund to the commissioner of human 
9.34 	services for shelter needy payments under section 3.