1.1 	A bill for an act
1.2 	relating to human services; making changes to continuing care provisions; 
1.3 	changing long-term care provisions; allowing electronic meetings; altering 
1.4 	service standards; amending Medicaid waivers for elderly services; modifying 
1.5 	personal care assistant services; amending Minnesota Statutes 2006, sections 
1.6 	144A.351; 256.9741, subdivisions 1, 3; 256.9742, subdivisions 3, 4, 6; 256.975, 
1.7 	by adding a subdivision; 256B.0655, subdivision 1f, by adding subdivisions; 
1.8 	256B.0911, subdivisions 3a, 4b, 6, 7, by adding a subdivision; 256B.0913, 
1.9 	subdivisions 4, 5a; 256B.0915; 256B.27, subdivision 2a; repealing Minnesota 
1.10 	Statutes 2006, section 256.9743.
1.11 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.12 	Section 1. Minnesota Statutes 2006, section 144A.351, is amended to read:
1.13 	144A.351 BALANCING LONG-TERM CARE: REPORT REQUIRED.
1.14 	The commissioners of health and human services, with the cooperation of counties 
1.15 	and regional entities, shall prepare a report to the legislature by JanuaryAugust 15, 2004, 
1.16 	and biennially thereafter, regarding the status of the full range of long-term care services 
1.17 	for the elderly in Minnesota. The report shall address:
1.18 	(1) demographics and need for long-term care in Minnesota;
1.19 	(2) summary of county and regional reports on long-term care gaps, surpluses, 
1.20 	imbalances, and corrective action plans;
1.21 	(3) status of long-term care services by county and region including:
1.22 	(i) changes in availability of the range of long-term care services and housing 
1.23 	options;
1.24 	(ii) access problems regarding long-term care; and
1.25 	(iii) comparative measures of long-term care availability and progress over time; and
2.1 	(4) recommendations regarding goals for the future of long-term care services, 
2.2 	policy changes, and resource needs.

2.3 	Sec. 2. Minnesota Statutes 2006, section 256.9741, subdivision 1, is amended to read:
2.4 		Subdivision 1.Long-term care facility. "Long-term care facility" means a nursing 
2.5 	home licensed under sections 144A.02 to 144A.10or; a boarding care home licensed 
2.6 	under sections 144.50 to 144.56; or a licensed or registered residential setting that provides 
2.7 	or arranges for the provision of home care services. 

2.8 	Sec. 3. Minnesota Statutes 2006, section 256.9741, subdivision 3, is amended to read:
2.9 		Subd. 3.Client. "Client" means an individual who requests, or on whose behalf a 
2.10 	request is made for, ombudsman services and is (a) a resident of a long-term care facility 
2.11 	or (b) a Medicare beneficiary who requests assistance relating to access, discharge, or 
2.12 	denial of inpatient or outpatient services, or (c) an individual reserving, receiving, or 
2.13 	requesting a home care service.

2.14 	Sec. 4. Minnesota Statutes 2006, section 256.9742, subdivision 3, is amended to read:
2.15 		Subd. 3.Posting. Every long-term care facility and acute care facility shall post in a 
2.16 	conspicuous place the address and telephone number of the office. A home care service 
2.17 	provider shall provide all recipients, including those in elderly housing with services 
2.18 	under chapter 144D, with the address and telephone number of the office. Counties shall 
2.19 	provide clients receiving a consumer support grant or a service allowancelong-term care 
2.20 	consultation services under section 256B.0911 or home and community-based services 
2.21 	through a state or federally funded program with the name, address, and telephone number 
2.22 	of the office. The posting or notice is subject to approval by the ombudsman.

2.23 	Sec. 5. Minnesota Statutes 2006, section 256.9742, subdivision 4, is amended to read:
2.24 		Subd. 4.Access to long-term care and acute care facilities and clients. The 
2.25 	ombudsman or designee may:
2.26 	(1) enter any long-term care facility without notice at any time;
2.27 	(2) enter any acute care facility without notice during normal business hours;
2.28 	(3) enter any acute care facility without notice at any time to interview a patient or 
2.29 	observe services being provided to the patient as part of an investigation of a matter that is 
2.30 	within the scope of the ombudsman's authority, but only if the ombudsman's or designee's 
2.31 	presence does not intrude upon the privacy of another patient or interfere with routine 
2.32 	hospital services provided to any patient in the facility;
3.1 	(4) communicate privately and without restriction with any client in accordance 
3.2 	with section 144.651, as long as the ombudsman has the client's consent for such 
3.3 	communication; 
3.4 	(5) inspect records of a long-term care facility, home care service provider, or acute 
3.5 	care facility that pertain to the care of the client according to sectionssection 144.335and 
3.6 	144.651; and 
3.7 	(6) with the consent of a client or client's legal guardian, the ombudsman or 
3.8 	designated staff shall have access to review records pertaining to the care of the client 
3.9 	according to sectionssection 144.335and 144.651. If a client cannot consent and has no 
3.10 	legal guardian, access to the records is authorized by this section. 
3.11 	A person who denies access to the ombudsman or designee in violation of this 
3.12 	subdivision or aids, abets, invites, compels, or coerces another to do so is guilty of a 
3.13 	misdemeanor.

3.14 	Sec. 6. Minnesota Statutes 2006, section 256.9742, subdivision 6, is amended to read:
3.15 		Subd. 6.Prohibition against discrimination or retaliation. (a) No entity shall take 
3.16 	discriminatory, disciplinary, or retaliatory action against an employee or volunteer, or a 
3.17 	patient, resident, or guardian or family member of a patient, resident, or guardian for filing 
3.18 	in good faith a complaint with or providing information to the ombudsman or designee 
3.19 	including volunteers. A person who violates this subdivision or who aids, abets, invites, 
3.20 	compels, or coerces another to do so is guilty of a misdemeanor.
3.21 	(b) There shall be a rebuttable presumption that any adverse action, as defined below, 
3.22 	within 90 days of report, is discriminatory, disciplinary, or retaliatory. For the purpose 
3.23 	of this clause, the term "adverse action" refers to action taken by the entity involved in a 
3.24 	report against the person making the report or the person with respect to whom the report 
3.25 	was made because of the report, and includes, but is not limited to:
3.26 	(1) discharge or transfer from a facility;
3.27 	(2) termination of service;
3.28 	(3) restriction or prohibition of access to the facility or its residents;
3.29 	(4) discharge from or termination of employment;
3.30 	(5) demotion or reduction in remuneration for services; and
3.31 	(6) any restriction of rights set forth in section 144.651or,144A.44, or 144A.751. 

3.32 	Sec. 7. Minnesota Statutes 2006, section 256.975, is amended by adding a subdivision 
3.33 	to read:
4.1 		Subd. 2a.Electronic meetings. (a) Notwithstanding section 13D.01, the Minnesota 
4.2 	Board on Aging may conduct a meeting of its members by telephone or other electronic 
4.3 	means so long as the following conditions are met:
4.4 	(1) all members of the board participating in the meeting, wherever their physical 
4.5 	location, can hear one another and can hear all discussion and testimony;
4.6 	(2) members of the public present at the regular meeting location of the board can 
4.7 	hear all discussion and testimony and all votes of members of the board;
4.8 	(3) at least one member of the board is physically present at the regular meeting 
4.9 	location; and
4.10 	(4) all votes are conducted by roll call, so that each member's vote on each issue 
4.11 	can be identified and recorded.
4.12 	(b) Each member of the board participating in a meeting by telephone or other 
4.13 	electronic means is considered present at the meeting for purposes of determining a 
4.14 	quorum and participating in all proceedings.
4.15 	(c) If telephone or other electronic means is used to conduct a meeting, the board, 
4.16 	to the extent practical, shall allow a person to monitor the meeting electronically from 
4.17 	a remote location. The board may require the person making a connection to pay for 
4.18 	documented marginal costs that the board incurs as a result of the additional connection.
4.19 	(d) If telephone or other electronic means is used to conduct a regular, special, or 
4.20 	emergency meeting, the board shall provide notice of the regular meeting location, of the 
4.21 	fact that some members may participate by telephone or other electronic means, and of 
4.22 	the provisions of paragraph (c). The timing and method of providing notice is governed 
4.23 	by section 13D.04.

4.24 	Sec. 8. Minnesota Statutes 2006, section 256B.0655, subdivision 1f, is amended to 
4.25 	read:
4.26 		Subd. 1f.Personal care assistant. (a) "Personal care assistant" means a person who:
4.27 	(1) is at least 18 years old, except for persons 16 to 18 years of age who participated 
4.28 	in a related school-based job training program or have completed a certified home health 
4.29 	aide competency evaluation;
4.30 	(2) is able to effectively communicate with the recipient and personal care provider 
4.31 	organization;
4.32 	(3) effective July 1, 1996, has completed one of the training requirements as 
4.33 	specified in Minnesota Rules, part 9505.0335, subpart 3, items A to E in paragraph (b);
5.1 	(4) has the ability to, and provides covered personal care assistant services according 
5.2 	to the recipient's care plan, responds appropriately to recipient needs, and reports changes 
5.3 	in the recipient's condition to the supervising qualified professional or physician;
5.4 	(5) is not a consumer of personal care assistant services;
5.5 	(6) maintains daily written records detailing:
5.6 	(i) the actual services provided to the recipient; and
5.7 	(ii) the amount of time spent providing the services; and
5.8 	(7) is subject to criminal background checks and procedures specified in chapter 
5.9 	245C.
5.10 	(b) Personal care assistant training must include successful completion of one or 
5.11 	more training requirements in:
5.12 	(1) a nursing assistant training program or its equivalent for which competency as a 
5.13 	nursing assistant is determined according to a test administered by the Minnesota State 
5.14 	Board of Technical Colleges;
5.15 	(2) a homemaker home health aide preservice training program using a curriculum 
5.16 	recommended by the Department of Health;
5.17 	(3) an accredited educational program for registered nurses or licensed practical 
5.18 	nurses;
5.19 	(4) a training program that provides the assistant with skills required to perform 
5.20 	personal care assistant services specified in subdivision 2, paragraph (d); or
5.21 	(5) a determination by the personal care provider that the assistant has, through 
5.22 	training or experience, the skills required to perform the personal care services specified in 
5.23 	subdivision 2.

5.24 	Sec. 9. Minnesota Statutes 2006, section 256B.0655, is amended by adding a 
5.25 	subdivision to read:
5.26 		Subd. 11.Personal care provider; eligibility. The department may contract 
5.27 	with an agency to provide personal care services to qualified recipients. To be eligible 
5.28 	to contract with the department as a personal care provider, an agency must meet the 
5.29 	criteria in clauses (1) to (12):
5.30 	(1) possess the capacity to enter into a legally binding contract;
5.31 	(2) possess demonstrated ability to fulfill the responsibilities in this subdivision 
5.32 	and subdivision 12;
5.33 	(3) demonstrate the cost-effectiveness of its proposal for the provision of personal 
5.34 	care services;
5.35 	(4) comply with Minnesota Rules, part 9505.0210;
6.1 	(5) demonstrate a knowledge of, sensitivity to, and experience with the special 
6.2 	needs, including communication needs and independent living needs, of the condition of 
6.3 	the recipient;
6.4 	(6) ensure that personal care services are provided in a manner consistent with the 
6.5 	recipient's ability to live independently;
6.6 	(7) provide a quality assurance mechanism;
6.7 	(8) demonstrate the financial ability to produce a cash flow sufficient to cover 
6.8 	operating expenses for 30 days;
6.9 	(9) disclose fully the names of persons with an ownership or control interest of five 
6.10 	percent or more in the contracting agency;
6.11 	(10) demonstrate an accounting or financial system that complies with generally 
6.12 	accepted accounting principles;
6.13 	(11) demonstrate a system of personnel management; and
6.14 	(12) if offering personal care services to a ventilator dependent recipient, 
6.15 	demonstrate the ability to train and to supervise the personal care assistant and the 
6.16 	recipient in ventilator operation and maintenance.

6.17 	Sec. 10. Minnesota Statutes 2006, section 256B.0655, is amended by adding a 
6.18 	subdivision to read:
6.19 		Subd. 12.Personal care provider responsibilities. The personal care provider 
6.20 	shall:
6.21 	(1) employ or contract with services staff to provide personal care services and to 
6.22 	train services staff as necessary;
6.23 	(2) supervise the personal care services as provided in subdivision 2, paragraph (f);
6.24 	(3) employ a personal care assistant that a qualified recipient brings to the personal 
6.25 	care provider as the recipient's choice of assistant and who meets the employment 
6.26 	qualifications of the provider, except that a personal care provider who must comply with 
6.27 	the requirements of a governmental personnel administration system is exempt from 
6.28 	this clause;
6.29 	(4) bill the medical assistance program for a personal care service by the personal 
6.30 	care assistant and a visit by the qualified professional supervising the personal care 
6.31 	assistant;
6.32 	(5) establish a grievance mechanism to resolve consumer complaints about personal 
6.33 	care services, including the personal care provider's decision whether to employ the 
6.34 	qualified recipient's choice of a personal care assistant;
6.35 	(6) keep records as required in Minnesota Rules, parts 9505.2160 to 9505.2195;
7.1 	(7) perform functions and provide services specified in the personal care provider's 
7.2 	contract;
7.3 	(8) comply with applicable rules and statutes; and
7.4 	(9) perform other functions as necessary to carry out the responsibilities in clauses 
7.5 	(1) to (9).

7.6 	Sec. 11. Minnesota Statutes 2006, section 256B.0655, is amended by adding a 
7.7 	subdivision to read:
7.8 		Subd. 13.Personal care provider; employment prohibition. A personal care 
7.9 	provider shall not employ a person to provide personal care service for a qualified 
7.10 	recipient if the person:
7.11 	(1) refuses to provide full disclosure of criminal history records as specified in 
7.12 	subdivision 1g, paragraph (b);
7.13 	(2) has been convicted of a crime that directly relates to the occupation of providing 
7.14 	personal care services to a qualified recipient;
7.15 	(3) has jeopardized the health or welfare of a vulnerable adult through physical 
7.16 	abuse, sexual abuse, or neglect as defined in section 626.557; or
7.17 	(4) is misusing or is dependent on mood-altering chemicals, including alcohol, to 
7.18 	the extent that the personal care provider knows or has reason to believe that the use of 
7.19 	chemicals has a negative effect on the person's ability to provide personal care services 
7.20 	or the use of chemicals is apparent during the hours the person is providing personal 
7.21 	care services.

7.22 	Sec. 12. Minnesota Statutes 2006, section 256B.0655, is amended by adding a 
7.23 	subdivision to read:
7.24 		Subd. 14.Supervision of personal care services. A personal care service to a 
7.25 	qualified recipient as described in subdivision 4 shall be under the supervision of a 
7.26 	qualified professional who shall have the following duties:
7.27 	(1) ensure that the personal care assistant is capable of providing the required 
7.28 	personal care services through direct observation of the assistant's work or through 
7.29 	consultation with the qualified recipient;
7.30 	(2) ensure that the personal care assistant is knowledgeable about the plan of 
7.31 	personal care services before the personal care assistant performs personal care services;
7.32 	(3) ensure that the personal care assistant is knowledgeable about essential 
7.33 	observations of the recipient's health, and about any conditions that should be immediately 
7.34 	brought to the attention of either the qualified professional or the attending physician;
8.1 	(4) evaluate the personal care services of a recipient through direct observation of 
8.2 	the personal care assistant's work or through consultation with the qualified recipient. 
8.3 	Evaluation shall be made:
8.4 	(i) within 14 days after the placement of a personal care assistant with the qualified 
8.5 	recipient;
8.6 	(ii) at least once every 30 days during the first 90 days after the qualified recipient 
8.7 	first receives personal care services according to the plan of personal care service; and
8.8 	(iii) at least once every 120 days following the period of evaluations in item (ii). The 
8.9 	qualified professional shall record in writing the results of the evaluation and actions taken 
8.10 	to correct any deficiencies in the work of the personal care assistant;
8.11 	(5) review, together with the recipient, and revise, as necessary, the plan of 
8.12 	personal care services at least once every 120 days after a plan of personal care services 
8.13 	is developed;
8.14 	(6) ensure that the personal care assistant and recipient are knowledgeable about a 
8.15 	change in the plan of personal care services;
8.16 	(7) ensure that records are kept, showing the services provided to the recipient 
8.17 	by the personal care assistant as described in subdivision 2, paragraph (f), and the time 
8.18 	spent providing the services;
8.19 	(8) determine that a qualified recipient is still capable of directing the recipient's 
8.20 	own care or has a responsible party; and
8.21 	(9) determine with a physician that a recipient is a qualified recipient.

8.22 	Sec. 13. Minnesota Statutes 2006, section 256B.0911, subdivision 3a, is amended to 
8.23 	read:
8.24 		Subd. 3a.Assessment and support planning. (a) Persons requesting assessment, 
8.25 	services planning, or other assistance intended to support community-based living, 
8.26 	including persons who need assessment in order to determine waiver or alternative care 
8.27 	program eligibility, must be visited by a long-term care consultation team within ten 
8.28 	working days after the date on which an assessment was requested or recommended. 
8.29 	Assessments must be conducted according to paragraphs (b) to (g) (i).
8.30 	(b) The county may utilize a team of either the social worker or public health nurse, 
8.31 	or both, to conduct the assessment in a face-to-face interview. The consultation team 
8.32 	members must confer regarding the most appropriate care for each individual screened or 
8.33 	assessed.
8.34 	(c) The long-term care consultation team must assess the health and social needs of 
8.35 	the person, using an assessment form provided by the commissioner.
9.1 	(d) The team must conduct the assessment in a face-to-face interview with the 
9.2 	person being assessed and the person's legal representative, if applicable.
9.3 	(e) The team must provide the person, or the person's legal representative, with 
9.4 	written recommendations for facility- or community-based services. The team must 
9.5 	document that the most cost-effective alternatives available were offered to the individual. 
9.6 	For purposes of this requirement, "cost-effective alternatives" means community services 
9.7 	and living arrangements that cost the same as or less than nursing facility care.
9.8 	(f) If the person chooses to use community-based services, the team must provide 
9.9 	the person or the person's legal representative with a written community support plan, 
9.10 	regardless of whether the individual is eligible for Minnesota health care programs. 
9.11 	The person may request assistance in developing a community support plan without 
9.12 	participating in a complete assessment.
9.13 	(g) The person has the right to make the final decision between nursing facility 
9.14 	placement and community placement after the screening team's recommendation, except 
9.15 	as provided in subdivision 4a, paragraph (c).
9.16 	(h) The team must give the person receiving assessment or support planning, or 
9.17 	the person's legal representative, materials, and forms supplied by the commissioner 
9.18 	containing the following information:
9.19 	(1) the need for and purpose of preadmission screening and assessment if the person 
9.20 	selects nursing facility placement;
9.21 	(2) the role of the long term care consultation assessment and support planning in 
9.22 	waiver and alternative care program eligibility determination;
9.23 	(2) (3) information about Minnesota health care programs;
9.24 	(3) (4) the person's freedom to accept or reject the recommendations of the team;
9.25 	(4) (5) the person's right to confidentiality under the Minnesota Government Data 
9.26 	Practices Act, chapter 13; and
9.27 	(6) the long term care consultant's decision regarding the person's need for nursing 
9.28 	facility level of care;
9.29 	(5) (7) the person's right to appeal the decision regarding the need for nursing facility 
9.30 	level of care or the county's final decisions regarding public programs eligibility according 
9.31 	to section 256.045, subdivision 3. 
9.32 	(i) Face-to-face assessment completed as part of eligibility determination for 
9.33 	the alternative care, elderly waiver, community alternatives for disabled individuals, 
9.34 	community alternative care, and traumatic brain injury waiver programs under sections 
9.35 	256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more 
9.36 	than 60 calendar days after the date of assessment. The effective eligibility start date 
10.1 	for these programs can never be prior to the date of assessment. If an assessment was 
10.2 	completed more than 60 days before the effective waiver or alternative care program 
10.3 	eligibility start date, assessment and support plan information must be updated in a 
10.4 	face-to-face visit and documented in the department's Medicaid Management Information 
10.5 	System (MMIS). The effective date of program eligibility in this case cannot be prior to 
10.6 	the date the updated assessment is completed.

10.7 	Sec. 14. Minnesota Statutes 2006, section 256B.0911, subdivision 4b, is amended to 
10.8 	read:
10.9 		Subd. 4b.Exemptions and emergency admissions. (a) Exemptions from the 
10.10 	federal screening requirements outlined in subdivision 4a, paragraphs (b) and (c), are 
10.11 	limited to:
10.12 	(1) a person who, having entered an acute care facility from a certified nursing 
10.13 	facility, is returning to a certified nursing facility;
10.14 	(2) a person transferring from one certified nursing facility in Minnesota to another 
10.15 	certified nursing facility in Minnesota; and
10.16 	(3) a person, 21 years of age or older, who satisfies the following criteria, as specified 
10.17 	in Code of Federal Regulations, title 42, section 483.106(b)(2):
10.18 	(i) the person is admitted to a nursing facility directly from a hospital after receiving 
10.19 	acute inpatient care at the hospital;
10.20 	(ii) the person requires nursing facility services for the same condition for which 
10.21 	care was provided in the hospital; and
10.22 	(iii) the attending physician has certified before the nursing facility admission that 
10.23 	the person is likely to receive less than 30 days of nursing facility services.
10.24 	(b) Persons who are exempt from preadmission screening for purposes of level of 
10.25 	care determination include:
10.26 	(1) persons described in paragraph (a);
10.27 	(2) an individual who has a contractual right to have nursing facility care paid for 
10.28 	indefinitely by the veterans' administration;
10.29 	(3) an individual enrolled in a demonstration project under section 256B.69, 
10.30 	subdivision 8, at the time of application to a nursing facility; and
10.31 	(4) an individual currently being served under the alternative care program or under 
10.32 	a home and community-based services waiver authorized under section 1915(c) of the 
10.33 	federal Social Security Act; and.
10.34 	(5) individuals admitted to a certified nursing facility for a short-term stay, which 
10.35 	is expected to be 14 days or less in duration based upon a physician's certification, and 
11.1 	who have been assessed and approved for nursing facility admission within the previous 
11.2 	six months. This exemption applies only if the consultation team member determines at 
11.3 	the time of the initial assessment of the six-month period that it is appropriate to use the 
11.4 	nursing facility for short-term stays and that there is an adequate plan of care for return to 
11.5 	the home or community-based setting. If a stay exceeds 14 days, the individual must be 
11.6 	referred no later than the first county working day following the 14th resident day for a 
11.7 	screening, which must be completed within five working days of the referral. The payment 
11.8 	limitations in subdivision 7 apply to an individual found at screening to not meet the level 
11.9 	of care criteria for admission to a certified nursing facility.
11.10 	(c) Persons admitted to a Medicaid-certified nursing facility from the community 
11.11 	on an emergency basis as described in paragraph (d) or from an acute care facility on a 
11.12 	nonworking day must be screened the first working day after admission.
11.13 	(d) Emergency admission to a nursing facility prior to screening is permitted when 
11.14 	all of the following conditions are met:
11.15 	(1) a person is admitted from the community to a certified nursing or certified 
11.16 	boarding care facility during county nonworking hours;
11.17 	(2) a physician has determined that delaying admission until preadmission screening 
11.18 	is completed would adversely affect the person's health and safety;
11.19 	(3) there is a recent precipitating event that precludes the client from living safely in 
11.20 	the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's 
11.21 	inability to continue to provide care;
11.22 	(4) the attending physician has authorized the emergency placement and has 
11.23 	documented the reason that the emergency placement is recommended; and
11.24 	(5) the county is contacted on the first working day following the emergency 
11.25 	admission.
11.26 	Transfer of a patient from an acute care hospital to a nursing facility is not considered 
11.27 	an emergency except for a person who has received hospital services in the following 
11.28 	situations: hospital admission for observation, care in an emergency room without hospital 
11.29 	admission, or following hospital 24-hour bed care.
11.30 	(e) A nursing facility must provide a written notice to persons who satisfy the criteria 
11.31 	in paragraph (a), clause (3),information to all persons admitted regarding the person's 
11.32 	right to request and receive long-term care consultation services as defined in subdivision 
11.33 	1a. The noticeinformation must be provided prior to the person's discharge from the 
11.34 	facility and in a format specified by the commissioner.

12.1 	Sec. 15. Minnesota Statutes 2006, section 256B.0911, subdivision 6, is amended to 
12.2 	read:
12.3 		Subd. 6.Payment for long-term care consultation services. (a) The total payment 
12.4 	for each county must be paid monthly by certified nursing facilities in the county. The 
12.5 	monthly amount to be paid by each nursing facility for each fiscal year must be determined 
12.6 	by dividing the county's annual allocation for long-term care consultation services by 12 
12.7 	to determine the monthly payment and allocating the monthly payment to each nursing 
12.8 	facility based on the number of licensed beds in the nursing facility. Payments to counties 
12.9 	in which there is no certified nursing facility must be made by increasing the payment 
12.10 	rate of the two facilities located nearest to the county seat.
12.11 	(b) The commissioner shall include the total annual payment determined under 
12.12 	paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
12.13 	according to section 256B.431, subdivision 2b, paragraph (g), or 256B.435.
12.14 	(c) In the event of the layaway, delicensure and decertification, or removal from 
12.15 	layaway of 25 percent or more of the beds in a facility, the commissioner may adjust 
12.16 	the per diem payment amount in paragraph (b) and may adjust the monthly payment 
12.17 	amount in paragraph (a). The effective date of an adjustment made under this paragraph 
12.18 	shall be on or after the first day of the month following the effective date of the layaway, 
12.19 	delicensure and decertification, or removal from layaway.
12.20 	(d) Payments for long-term care consultation services are available to the county 
12.21 	or counties to cover staff salaries and expenses to provide the services described in 
12.22 	subdivision 1a. The county shall employ, or contract with other agencies to employ, within 
12.23 	the limits of available funding, sufficient personnel to provide long-term care consultation 
12.24 	services while meeting the state's long-term care outcomes and objectives as defined in 
12.25 	section 256B.0917, subdivision 1. The county shall be accountable for meeting local 
12.26 	objectives as approved by the commissioner in the biennial home and community-based 
12.27 	services quality assurance plan on a form provided by the commissioner.
12.28 	(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the 
12.29 	screening costs under the medical assistance program may not be recovered from a facility.
12.30 	(f) The commissioner of human services shall amend the Minnesota medical 
12.31 	assistance plan to include reimbursement for the local consultation teams.
12.32 	(g) The county may bill, as case management services, assessments, support 
12.33 	planning, and follow-along provided to persons determined to be eligible for case 
12.34 	management under Minnesota health care programs. No individual or family member 
12.35 	shall be charged for an initial assessment or initial support plan development provided 
12.36 	under subdivision 3a or 3b.

13.1 	Sec. 16. Minnesota Statutes 2006, section 256B.0911, is amended by adding a 
13.2 	subdivision to read:
13.3 		Subd. 6a.Withholding. If any provider obligated to pay the long-term care 
13.4 	consultation amount as described in subdivision 6 is more than two months delinquent in 
13.5 	the timely payment of the monthly installment, the commissioner may withhold payments, 
13.6 	penalties, and interest in accordance with the methods outlined in section 256.9657, 
13.7 	subdivision 7a. Any amount withheld under this provision must be returned to the county 
13.8 	to whom the delinquent payments were due.

13.9 	Sec. 17. Minnesota Statutes 2006, section 256B.0911, subdivision 7, is amended to 
13.10 	read:
13.11 		Subd. 7.Reimbursement for certified nursing facilities. (a) Medical assistance 
13.12 	reimbursement for nursing facilities shall be authorized for a medical assistance recipient 
13.13 	only if a preadmission screening has been conducted prior to admission or the county has 
13.14 	authorized an exemption. Medical assistance reimbursement for nursing facilities shall 
13.15 	not be provided for any recipient who the local screener has determined does not meet the 
13.16 	level of care criteria for nursing facility placement or, if indicated, has not had a level II 
13.17 	OBRA evaluation as required under the federal Omnibus Budget Reconciliation Act of 
13.18 	1987 completed unless an admission for a recipient with mental illness is approved by the 
13.19 	local mental health authority or an admission for a recipient with developmental disability 
13.20 	is approved by the state developmental disability authority.
13.21 	(b) The nursing facility must not bill a person who is not a medical assistance 
13.22 	recipient for resident days that preceded the date of completion of screening activities as 
13.23 	required under subdivisions 4a, 4b, and 4c. The nursing facility must include unreimbursed 
13.24 	resident days in the nursing facility resident day totals reported to the commissioner.
13.25 	(c) The commissioner shall make a request to the Centers for Medicare and Medicaid 
13.26 	Services for a waiver allowing team approval of Medicaid payments for certified nursing 
13.27 	facility care. An individual has a choice and makes the final decision between nursing 
13.28 	facility placement and community placement after the screening team's recommendation, 
13.29 	except as provided in subdivision 4a, paragraph (c).

13.30 	Sec. 18. Minnesota Statutes 2006, section 256B.0913, subdivision 4, is amended to 
13.31 	read:
13.32 		Subd. 4.Eligibility for funding for services for nonmedical assistance recipients.
 13.33 	(a) Funding for services under the alternative care program is available to persons who 
13.34 	meet the following criteria:
14.1 	(1) the person has been determined by a community assessment under section 
14.2 	256B.0911 to be a person who would require the level of care provided in a nursing 
14.3 	facility, but for the provision of services under the alternative care program;
14.4 	(2) the person is age 65 or older;
14.5 	(3) the person would be eligible for medical assistance within 135 days of admission 
14.6 	to a nursing facility;
14.7 	(4) the person is not ineligible for the payment of long-term care services by the
14.8 	medical assistance program due to an asset transfer penalty under section 256B.0595 or 
14.9 	equity interest in the home exceeding $500,000 as stated in section 256B.056;
14.10 	(5) the person needs services that are not funded through other state or federal 
14.11 	funding;
14.12 	(6) the monthly cost of the alternative care services funded by the program for 
14.13 	this person does not exceed 75 percent of the monthly limit described under section 
14.14 	256B.0915, subdivision 3a. This monthly limit does not prohibit the alternative care client 
14.15 	from payment for additional services, but in no case may the cost of additional services 
14.16 	purchased under this section exceed the difference between the client's monthly service 
14.17 	limit defined under section 256B.0915, subdivision 3, and the alternative care program 
14.18 	monthly service limit defined in this paragraph. If medical supplies and equipment or 
14.19 	environmental modifications are or will be purchased for an alternative care services 
14.20 	recipient, the costs may be prorated on a monthly basis for up to 12 consecutive months 
14.21 	beginning with the month of purchase. If the monthly cost of a recipient's other alternative 
14.22 	care services exceeds the monthly limit established in this paragraph, the annual cost of the 
14.23 	alternative care services shall be determined. In this event, the annual cost of alternative 
14.24 	care services shall not exceed 12 times the monthly limit described in this paragraph; and
14.25 	(7) the person is making timely payments of the assessed monthly fee.
14.26 	A person is ineligible if payment of the fee is over 60 days past due, unless the person 
14.27 	agrees to:
14.28 	(i) the appointment of a representative payee;
14.29 	(ii) automatic payment from a financial account;
14.30 	(iii) the establishment of greater family involvement in the financial management of 
14.31 	payments; or
14.32 	(iv) another method acceptable to the county to ensure prompt fee payments.
14.33 	The county shall extend the client's eligibility as necessary while making 
14.34 	arrangements to facilitate payment of past-due amounts and future premium payments. 
14.35 	Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be 
14.36 	reinstated for a period of 30 days.
15.1 	(b) Alternative care funding under this subdivision is not available for a person 
15.2 	who is a medical assistance recipient or who would be eligible for medical assistance 
15.3 	without a spenddown or waiver obligation. A person whose initial application for medical 
15.4 	assistance and the elderly waiver program is being processed may be served under the 
15.5 	alternative care program for a period up to 60 days. If the individual is found to be eligible 
15.6 	for medical assistance, medical assistance must be billed for services payable under the 
15.7 	federally approved elderly waiver plan and delivered from the date the individual was 
15.8 	found eligible for the federally approved elderly waiver plan. Notwithstanding this 
15.9 	provision, alternative care funds may not be used to pay for any service the cost of which: 
15.10 	(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation; 
15.11 	or (iii) is used to pay a medical assistance income spenddown for a person who is eligible 
15.12 	to participate in the federally approved elderly waiver program under the special income 
15.13 	standard provision.
15.14 	(c) Alternative care funding is not available for a person who resides in a licensed 
15.15 	nursing home, certified boarding care home, hospital, or intermediate care facility, except 
15.16 	for case management services which are provided in support of the discharge planning 
15.17 	process for a nursing home resident or certified boarding care home resident to assist with 
15.18 	a relocation process to a community-based setting.
15.19 	(d) Alternative care funding is not available for a person whose income is greater 
15.20 	than the maintenance needs allowance under section 256B.0915, subdivision 1d, but 
15.21 	equal to or less than 120 percent of the federal poverty guideline effective July 1 in the 
15.22 	year for which alternative care eligibility is determined, who would be eligible for the 
15.23 	elderly waiver with a waiver obligation.

15.24 	Sec. 19. Minnesota Statutes 2006, section 256B.0913, subdivision 5a, is amended to 
15.25 	read:
15.26 		Subd. 5a.Services; service definitions; service standards. (a) Unless specified in 
15.27 	statute, the services, service definitions, and standards for alternative care services shall 
15.28 	be the same as the services, service definitions, and standards specified in the federally 
15.29 	approved elderly waiver plan, except foralternative care does not cover transitional 
15.30 	support services, assisted living services, adult foster care services, and residential care 
15.31 	services and benefits defined under section 256B.0625 that meet primary and acute 
15.32 	health care needs.
15.33 	(b) The county agency must ensure that the funds are not used to supplant or 
15.34 	supplement services available through other public assistance or services programs., 
15.35 	including supplementation of client co-pays, deductibles, premiums, or other cost-sharing 
16.1 	arrangements for health-related benefits and services or entitlement programs and services 
16.2 	that are available to the person, but in which they have elected not to enroll. For a provider 
16.3 	of supplies and equipment when the monthly cost of the supplies and equipment is less 
16.4 	than $250, persons or agencies must be employed by or under a contract with the county 
16.5 	agency or the public health nursing agency of the local board of health in order to receive 
16.6 	funding under the alternative care program. Supplies and equipment may be purchased 
16.7 	from a vendor not certified to participate in the Medicaid program if the cost for the 
16.8 	item is less than that of a Medicaid vendor.
16.9 	(c) Personal care services must meet the service standards defined in the federally 
16.10 	approved elderly waiver plan, except that a county agency may contract with a client's 
16.11 	relative who meets the relative hardship waiver requirements or a relative who meets the 
16.12 	criteria and is also the responsible party under an individual service plan that ensures the 
16.13 	client's health and safety and supervision of the personal care services by a qualified 
16.14 	professional as defined in section 256B.0625, subdivision 19c. Relative hardship is 
16.15 	established by the county when the client's care causes a relative caregiver to do any of the 
16.16 	following: resign from a paying job, reduce work hours resulting in lost wages, obtain a 
16.17 	leave of absence resulting in lost wages, incur substantial client-related expenses, provide 
16.18 	services to address authorized, unstaffed direct care time, or meet special needs of the 
16.19 	client unmet in the formal service plan.

16.20 	Sec. 20. Minnesota Statutes 2006, section 256B.0915, is amended to read:
16.21 	256B.0915 MEDICAID WAIVER FOR ELDERLY SERVICES.
16.22 		Subdivision 1.Authority. The commissioner is authorized to apply for a home 
16.23 	and community-based services waiver for the elderly, authorized under section 1915(c) 
16.24 	of the Social Security Act, in order to obtain federal financial participation to expand 
16.25 	the availability of services for persons who are eligible for medical assistance. The 
16.26 	commissioner may apply for additional waivers or pursue other federal financial 
16.27 	participation which is advantageous to the state for funding home care services for the 
16.28 	frail elderly who are eligible for medical assistance. The provision of waivered services 
16.29 	to elderly and disabled medical assistance recipients must comply with the criteria for 
16.30 	service definitions and provider standards approved in the waiver.
16.31 		Subd. 1a.Elderly waiver case management services. (a) Elderly case management 
16.32 	services under the home and community-based services waiver for elderly individuals are 
16.33 	available from providers meeting qualification requirements and the standards specified 
16.34 	in subdivision 1b. Eligible recipients may choose any qualified provider of elderly case 
16.35 	management services.
17.1 	Case management services assist individuals who receive waiver services in gaining 
17.2 	access to needed waiver and other state plan services, as well as needed medical, social, 
17.3 	educational, and other services regardless of the funding source for the services to which 
17.4 	access is gained.
17.5 	A case aide shall provide assistance to the case manager in carrying out 
17.6 	administrative activities of the case management function. The case aide may not assume 
17.7 	responsibilities that require professional judgment including assessments, reassessments, 
17.8 	and care plan development. The case manager is responsible for providing oversight of 
17.9 	the case aide.
17.10 	Case managers shall be responsible for ongoing monitoring of the provision of 
17.11 	services included in the individual's plan of care. Case managers shall initiate and oversee 
17.12 	the process of assessment and reassessment of the individual's care and review plan of 
17.13 	care at intervals specified in the federally approved waiver plan.
17.14 	(b) The county of service or tribe must provide access to and arrange for case 
17.15 	management services. County of service has the meaning given it in Minnesota Rules, 
17.16 	part 9505.0015, subpart 11.
17.17 		Subd. 1b.Provider qualifications and standards. The commissioner must 
17.18 	enroll qualified providers of elderly case management services under the home 
17.19 	and community-based waiver for the elderly under section 1915(c) of the Social 
17.20 	Security Act. The enrollment process shall ensure the provider's ability to meet the 
17.21 	qualification requirements and standards in this subdivision and other federal and state 
17.22 	requirements of this service. An elderly case management provider is an enrolled medical 
17.23 	assistance provider who is determined by the commissioner to have all of the following 
17.24 	characteristics:
17.25 	(1) the demonstrated capacity and experience to provide the components of 
17.26 	case management to coordinate and link community resources needed by the eligible 
17.27 	population;
17.28 	(2) administrative capacity and experience in serving the target population for 
17.29 	whom it will provide services and in ensuring quality of services under state and federal 
17.30 	requirements;
17.31 	(3) a financial management system that provides accurate documentation of services 
17.32 	and costs under state and federal requirements;
17.33 	(4) the capacity to document and maintain individual case records under state and 
17.34 	federal requirements; and
17.35 	(5) the countylead agency may allow a case manager employed by the countylead 
17.36 	agency to delegate certain aspects of the case management activity to another individual 
18.1 	employed by the countylead agency provided there is oversight of the individual by 
18.2 	the case manager. The case manager may not delegate those aspects which require 
18.3 	professional judgment including assessments, reassessments, and care plan development.
18.4 	Lead agencies include counties, health plans, and federally recognized tribes who 
18.5 	authorize services under this section.
18.6 		Subd. 1c.Case management activities under the state plan. The commissioner 
18.7 	shall seek an amendment to the home and community-based services waiver for the 
18.8 	elderly to implement the provisions of subdivisions 1a and 1b. If the commissioner 
18.9 	is unable to secure the approval of the secretary of health and human services for the 
18.10 	requested waiver amendment by December 31, 1993, the commissioner shall amend 
18.11 	the medical assistance state plan to provide that case management provided under the 
18.12 	home and community-based services waiver for the elderly is performed by counties 
18.13 	as an administrative function for the proper and effective administration of the state 
18.14 	medical assistance plan. The state shall reimburse counties for the nonfederal share of 
18.15 	costs for case management performed as an administrative function under the home and 
18.16 	community-based services waiver for the elderly.
18.17 		Subd. 1d.Posteligibility treatment of income and resources for elderly waiver.
 18.18 	Notwithstanding the provisions of section 256B.056, the commissioner shall make the 
18.19 	following amendment to the medical assistance elderly waiver program effective July 1, 
18.20 	1999, or upon federal approval, whichever is later. 
18.21 	A recipient's maintenance needs will be an amount equal to the Minnesota 
18.22 	supplemental aid equivalent rate as defined in section 256I.03, subdivision 5, plus the 
18.23 	medical assistance personal needs allowance as defined in section 256B.35, subdivision 
18.24 	1, paragraph (a), when applying posteligibility treatment of income rules to the gross 
18.25 	income of elderly waiver recipients, except for individuals whose income is in excess of 
18.26 	the special income standard according to Code of Federal Regulations, title 42, section 
18.27 	435.236. Recipient maintenance needs shall be adjusted under this provision each July 1. 
18.28 		Subd. 2.Spousal impoverishment policies. The commissioner shall seek to amend 
18.29 	the federal waiver and the medical assistance state plan to allowapply:
18.30 	(1) the spousal impoverishment criteria as authorized under United States Code, title 
18.31 	42, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059, 
18.32 	except that the amendment shall seek to add to;
18.33 	(2)  the personal needs allowance permitted in section 256B.0575,; and
18.34 	(3) an amount equivalent to the group residential housing rate as set by section 
18.35 	256I.03, subdivision 5, and according to the approved federal waiver and medical 
18.36 	assistance state plan. 
19.1 		Subd. 3.Limits of cases. The number of medical assistance waiver recipients that 
19.2 	a countylead agency may serve must be allocated according to the number of medical 
19.3 	assistance waiver cases open on July 1 of each fiscal year. Additional recipients may be 
19.4 	served with the approval of the commissioner.
19.5 		Subd. 3a.Elderly waiver cost limits. (a) The monthly limit for the cost of waivered 
19.6 	services to an individual elderly waiver client shall be the weighted average monthly 
19.7 	nursing facility rate of the case mix resident class to which the elderly waiver client would 
19.8 	be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's 
19.9 	maintenance needs allowance as described in subdivision 1d, paragraph (a), until the first 
19.10 	day of the state fiscal year in which the resident assessment system as described in section 
19.11 	256B.437 for nursing home rate determination is implemented. Effective on the first day 
19.12 	of the state fiscal year in which the resident assessment system as described in section 
19.13 	256B.437 for nursing home rate determination is implemented and the first day of each 
19.14 	subsequent state fiscal year, the monthly limit for the cost of waivered services to an 
19.15 	individual elderly waiver client shall be the rate of the case mix resident class to which the 
19.16 	waiver client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, 
19.17 	in effect on the last day of the previous state fiscal year, adjusted by the greater of any 
19.18 	legislatively adopted home and community-based services percentage rate increase or the 
19.19 	average statewide percentage increase in nursing facility payment rates. 
19.20 	(b) If extended medical supplies and equipment or environmental modifications are 
19.21 	or will be purchased for an elderly waiver client, the costs may be prorated for up to 
19.22 	12 consecutive months beginning with the month of purchase. If the monthly cost of a 
19.23 	recipient's waivered services exceeds the monthly limit established in paragraph (a), the 
19.24 	annual cost of all waivered services shall be determined. In this event, the annual cost of 
19.25 	all waivered services shall not exceed 12 times the monthly limit of waivered services as 
19.26 	described in paragraph (a).
19.27 		Subd. 3b.Cost limits for elderly waiver applicants who reside in a nursing 
19.28 	facility. (a) For a person who is a nursing facility resident at the time of requesting a 
19.29 	determination of eligibility for elderly waivered services, a monthly conversion limit 
19.30 	for the cost of elderly waivered services may be requested. The monthly conversion 
19.31 	limit for the cost of elderly waiver services shall be the resident class assigned under 
19.32 	Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident in the nursing facility 
19.33 	where the resident currently resides until July 1 of the state fiscal year in which the 
19.34 	resident assessment system as described in section 256B.437256B.438 for nursing 
19.35 	home rate determination is implemented. Effective on July 1 of the state fiscal year in 
19.36 	which the resident assessment system as described in section 256B.437256B.438 for 
20.1 	nursing home rate determination is implemented, the monthly conversion limit for the 
20.2 	cost of elderly waiver services shall be the per diem nursing facility rate as determined 
20.3 	by the resident assessment system as described in section 256B.437 for that resident in 
20.4 	the nursing facility where the resident currently resides multiplied by 365 and divided 
20.5 	by 12, less the recipient's maintenance needs allowance as described in subdivision 1d. 
20.6 	The initially approved conversion rate may be adjusted by the greater of any subsequent 
20.7 	legislatively adopted home and community-based services percentage rate increase or 
20.8 	the average statewide percentage increase in nursing facility payment rates. The limit 
20.9 	under this subdivision only applies to persons discharged from a nursing facility after a 
20.10 	minimum 30-day stay and found eligible for waivered services on or after July 1, 1997. 
20.11 	For conversions from the nursing home to the elderly waiver with consumer directed 
20.12 	community support services, the conversion rate limit is equal to the nursing facility rate 
20.13 	reduced by a percentage equal to the percentage difference between the consumer directed 
20.14 	services budget limit that would be assigned according to the federally approved waiver 
20.15 	plan and the corresponding community case mix cap, but not to exceed 50 percent.
20.16 	(b) The following costs must be included in determining the total monthly costs 
20.17 	for the waiver client:
20.18 	(1) cost of all waivered services, including extended medical supplies and equipment 
20.19 	and environmental modifications and adaptations; and
20.20 	(2) cost of skilled nursing, home health aide, and personal care services reimbursable 
20.21 	by medical assistance.
20.22 		Subd. 3c.Service approval and contracting provisions. (a) Medical assistance 
20.23 	funding for skilled nursing services, private duty nursing, home health aide, and personal 
20.24 	care services for waiver recipients must be approved by the case manager and included in 
20.25 	the individual care plan.
20.26 	(b) A countylead agency is not required to contract with a provider of supplies and 
20.27 	equipment if the monthly cost of the supplies and equipment is less than $250.
20.28 		Subd. 3d.Adult foster care rate. The adult foster care rate shall be considered 
20.29 	a difficulty of care payment and shall not include room and board. The adult foster 
20.30 	care service rate shall be negotiated between the countylead agency and the foster care 
20.31 	provider. The elderly waiver payment for the foster care service in combination with 
20.32 	the payment for all other elderly waiver services, including case management, must not 
20.33 	exceed the limit specified in subdivision 3a, paragraph (a).
20.34 		Subd. 3e.Assisted livingCustomized living service rate. (a) Payment for assisted 
20.35 	living servicecustomized living services shall be a monthly rate negotiated and authorized 
20.36 	by the county agency based on an individualized service plan for each resident and may 
21.1 	not cover direct rent or food costs. lead agency within the parameters established by 
21.2 	the commissioner. The payment agreement must delineate the services that have been 
21.3 	customized for each recipient and specify the amount of each service to be provided. The 
21.4 	lead agency shall ensure that there is a documented need for all services authorized. 
21.5 	Customized living services must not include rent or raw food costs. The negotiated 
21.6 	payment rate must be based on services to be provided. Negotiated rates must not exceed 
21.7 	payment rates for comparable elderly waiver or medical assistance services and must 
21.8 	reflect economies of scale.
21.9 	(b) The individualized monthly negotiated payment for assisted livingcustomized 
21.10 	living services as described in section 256B.0913, subdivisions 5d to 5f, and residential 
21.11 	care services as described in section 256B.0913, subdivision 5c, shall not exceed the 
21.12 	nonfederal share, in effect on July 1 of the state fiscal year for which the rate limit 
21.13 	is being calculated, of the greater of either the statewide or any of the geographic 
21.14 	groups' weighted average monthly nursing facility rate of the case mix resident class 
21.15 	to which the elderly waiver eligible client would be assigned under Minnesota Rules, 
21.16 	parts 9549.0050 to 9549.0059, less the maintenance needs allowance as described in 
21.17 	subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in which the resident 
21.18 	assessment system as described in section 256B.437 for nursing home rate determination 
21.19 	is implemented. Effective on July 1 of the state fiscal year in which the resident 
21.20 	assessment system as described in section 256B.437 for nursing home rate determination 
21.21 	is implemented and July 1 of each subsequent state fiscal year, the individualized monthly 
21.22 	negotiated payment for the services described in this clause shall not exceed the limit 
21.23 	described in this clause which was in effect on June 30 of the previous state fiscal year 
21.24 	and which has been adjusted by the greater of any legislatively adopted home and 
21.25 	community-based services cost-of-living percentage increase or any legislatively adopted 
21.26 	statewide percent rate increase for nursing facilities. 
21.27 	(c) The individualized monthly negotiated payment for assisted Customized living 
21.28 	services described in section 144A.4605 and are delivered by a provider licensed by the 
21.29 	Department of Health as a class A or class F home care provider or an assisted living 
21.30 	home care provider and provided in a building that is registered as a housing with services 
21.31 	establishment under chapter 144D and that provides 24-hour supervision in combination 
21.32 	with the payment for other elderly waiver services, including case management, must not 
21.33 	exceed the limit specified in subdivision 3a. 
21.34 		Subd. 3f.Individual service rates; expenditure forecasts. (a) The countylead 
21.35 	agency shall negotiate individual service rates with vendors and may authorize payment 
21.36 	for actual costs up to the county'slead agency's current approved rate. Persons or agencies 
22.1 	must be employed by or under a contract with the countylead agency or the public health 
22.2 	nursing agency of the local board of health in order to receive funding under the elderly 
22.3 	waiver program, except as a provider of supplies and equipment when the monthly cost of 
22.4 	the supplies and equipment is less than $250.
22.5 	(b) Reimbursement for the medical assistance recipients under the approved waiver 
22.6 	shall be made from the medical assistance account through the invoice processing 
22.7 	procedures of the department's Medicaid Management Information System (MMIS), 
22.8 	only with the approval of the client's case manager. The budget for the state share of the 
22.9 	Medicaid expenditures shall be forecasted with the medical assistance budget, and shall 
22.10 	be consistent with the approved waiver.
22.11 		Subd. 3g.Service rate limits; state assumption of costs. (a) To improve access 
22.12 	to community services and eliminate payment disparities between the alternative care 
22.13 	program and the elderly waiver, the commissioner shall establish statewide maximum 
22.14 	service rate limits and eliminate county-specificlead agency-specific service rate limits.
22.15 	(b) Effective July 1, 2001, for service rate limits, except those described or defined in 
22.16 	subdivisions 3d and 3e, the rate limit for each service shall be the greater of the alternative 
22.17 	care statewide maximum rate or the elderly waiver statewide maximum rate.
22.18 	(c) CountiesLead agencies may negotiate individual service rates with vendors for 
22.19 	actual costs up to the statewide maximum service rate limit.
22.20 		Subd. 4.Termination notice. The case manager must give the individual a ten-day 
22.21 	written notice of any denial, reduction, or termination of waivered services.
22.22 		Subd. 5.Assessments and reassessments for waiver clients. Each client shall 
22.23 	receive an initial assessment of strengths, informal supports, and need for services in 
22.24 	accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a 
22.25 	client served under the elderly waiver must be conducted at least every 12 months and 
22.26 	at other times when the case manager determines that there has been significant change 
22.27 	in the client's functioning. This may include instances where the client is discharged 
22.28 	from the hospital. 
22.29 		Subd. 6.Implementation of care plan. Each elderly waiver client shall be provided 
22.30 	a copy of a written care plan that meets the requirements outlined in section 256B.0913, 
22.31 	subdivision 8. The care plan must be implemented by the county administering waivered 
22.32 	servicesof service when it is different than the county of financial responsibility. The 
22.33 	county of service administering waivered services must notify the county of financial 
22.34 	responsibility of the approved care plan.
22.35 		Subd. 7.Prepaid elderly waiver services. An individual for whom a prepaid health 
22.36 	plan is liable for nursing home services or elderly waiver services according to section 
23.1 	256B.69, subdivision 6a, is not eligible to also receive county-administered elderly waiver 
23.2 	services under this section. 
23.3 		Subd. 8.Services and supports. (a) Services and supports shall meet the 
23.4 	requirements set out in United States Code, title 42, section 1396n.
23.5 	(b) Services and supports shall promote consumer choice and be arranged and 
23.6 	provided consistent with individualized, written care plans.
23.7 	(c) The state of Minnesota, county, managed care organization, or tribal government 
23.8 	under contract to administer the elderly waiver shall not be liable for damages, injuries, 
23.9 	or liabilities sustained through the purchase of direct supports or goods by the person, 
23.10 	the person's family, or the authorized representatives with funds received through 
23.11 	consumer-directed community support services under the federally approved waiver plan. 
23.12 	Liabilities include, but are not limited to, workers' compensation liability, the Federal 
23.13 	Insurance Contributions Act (FICA), or the Federal Unemployment Tax Act (FUTA).
23.14 		Subd. 9.Tribal management of elderly waiver. Notwithstanding contrary 
23.15 	provisions of this section, or those in other state laws or rules, the commissioner may 
23.16 	develop a model for tribal management of the elderly waiver program and implement this 
23.17 	model through a contract between the state and any of the state's federally recognized tribal 
23.18 	governments. The model shall include the provision of tribal waiver case management, 
23.19 	assessment for personal care assistance, and administrative requirements otherwise carried 
23.20 	out by countieslead agencies but shall not include tribal financial eligibility determination 
23.21 	for medical assistance.

23.22 	Sec. 21. Minnesota Statutes 2006, section 256B.27, subdivision 2a, is amended to read:
23.23 		Subd. 2a.On-siteCost and statistical data audits. Each year The commissioner 
23.24 	shall provide for the on-sitean audit of the cost reportsand statistical data of nursing homes
23.25 	facilities participating as vendors of medical assistance. The commissioner shall select for 
23.26 	audit at least 15 percent of thesethe nursing homesfacility's data reported at random or 
23.27 	using factors including, but not limited to: data reported to the public as criteria for rating 
23.28 	nursing facilities; data used to set limits for other medical assistance programs or vendors 
23.29 	of services to nursing facilities; change in ownership; frequent changes in administration 
23.30 	in excess of normal turnover rates; complaints to the commissioner of health about care, 
23.31 	safety, or rights; where previous inspections or reinspections under section 144A.10 have 
23.32 	resulted in correction orders related to care, safety, or rights; or where persons involved in 
23.33 	ownership or administration of the facility have been indicted for alleged criminal activity. 
23.34 	The commissioner shall meet the 15 percent requirement by either conducting an 
23.35 	audit focused on an individual nursing facility, a group of facilities, or targeting specific 
24.1 	data categories in multiple nursing facilities. These audits may be conducted on-site 
24.2 	at the nursing facility, at office space used by a nursing facility or a nursing facility's 
24.3 	parent organization, or at the commissioner's office. Data being audited may be collected 
24.4 	electronically, in person, or by any other means the commissioner finds acceptable.

24.5 	Sec. 22.  REPEALER.
 24.6 	 Minnesota Statutes 2006, section 256.9743, is repealed.